MEDICARE: DR. MARC WEINBAUM M.D.

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	2084P0800X	Psychiatry Physician	19584SC	SC
2	2084P0802X	Addiction Psychiatry Physician	01029010C	IN
3	2084P0800X	Psychiatry Physician	ME53120	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	189903	OTHER	SC	APS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265507628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC WEINBAUM M.D.

Provider Business Mailing Address
First Line	:	3002 SE 1ST AVE
Second Line	:	BUILDING 100
City	:	OCALA
State	:	FL
Zip	:	34471-0477
Country	:	US
Telephone Number	:	352-732-0450
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002 SE 1ST AVE
Second Line	:	BUILDING 100
City	:	OCALA
State	:	FL
Zip	:	34471-0477
Country	:	US
Telephone Number	:	352-732-0450
Fax Number	:

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/05/2014

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