Healthcare Provider Details

I. General information

NPI: 1134172547
Provider Name (Legal Business Name): KARL E WEINGARTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 CENTRAL AVE
RIVERSIDE CA
92506-2918
US

IV. Provider business mailing address

PO BOX 25274
BELFAST ME
04915-2003
US

V. Phone/Fax

Practice location:
  • Phone: 951-248-1291
  • Fax:
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG80449
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number059669
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG80449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: