MEDICARE: BRUCE WEINER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD037122E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	478181	OTHER	NJ	BCBS

General Provider Information

NPI Number	:	1083618870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE WEINER MD

Provider Business Mailing Address
First Line	:	826 MAIN ST
Second Line	:	MOB II STE 203
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-4459
Country	:	US
Telephone Number	:	610-983-1980
Fax Number	:	610-422-5435

Provider Business Practice Location Address
First Line	:	826 MAIN ST
Second Line	:	MOB II STE 203
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-4459
Country	:	US
Telephone Number	:	610-983-1980
Fax Number	:	610-422-5435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/26/2012

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