Healthcare Provider Details

I. General information

NPI: 1528022621
Provider Name (Legal Business Name): WAYNE WEINREB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST SUITE 3A
NORTH READING MA
01864-5001
US

IV. Provider business mailing address

21 MAIN STREET SUITE 3A
NORTH READING MA
01864-3103
US

V. Phone/Fax

Practice location:
  • Phone: 978-276-0100
  • Fax: 978-276-0041
Mailing address:
  • Phone: 978-276-0100
  • Fax: 978-276-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54482
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: