Healthcare Provider Details

I. General information

NPI: 1649598871
Provider Name (Legal Business Name): NICHOLAS E WEINBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3936
  • Fax: 617-726-0311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18289
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number270455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: