Healthcare Provider Details

I. General information

NPI: 1194046144
Provider Name (Legal Business Name): DAVID A WEINSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 TAVISTOCK LAKES BLVD STE 360
ORLANDO FL
32827-7665
US

IV. Provider business mailing address

411 MAITLAND AVE STE 1001
ALTAMONTE SPRINGS FL
32701-5448
US

V. Phone/Fax

Practice location:
  • Phone: 407-266-3627
  • Fax: 407-882-4799
Mailing address:
  • Phone: 407-260-2606
  • Fax: 407-260-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME123822
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME123822
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME123822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: