Healthcare Provider Details

I. General information

NPI: 1689777039
Provider Name (Legal Business Name): MARTIN J WEINTRAUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON HEIGHTS MEDICAL CENTER
WESTMINSTER MD
21157-5633
US

IV. Provider business mailing address

200 WASHINGTON HEIGHTS MEDICAL CENTER
WESTMINSTER MD
21157-5633
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-4095
  • Fax: 410-848-5314
Mailing address:
  • Phone: 410-848-4095
  • Fax: 410-848-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD25813
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: