Healthcare Provider Details

I. General information

NPI: 1871797415
Provider Name (Legal Business Name): MARTIN WEINRAUCH P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 VILLAGE DR STE 104
FAYETTEVILLE NC
28304-3864
US

IV. Provider business mailing address

2850 VILLAGE DR STE 104
FAYETTEVILLE NC
28304-3864
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-4687
  • Fax: 910-483-4968
Mailing address:
  • Phone: 910-483-4687
  • Fax: 910-483-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number200001407621
License Number StateNC

VIII. Authorized Official

Name: MARTIN HOWARD WEINRAUCH
Title or Position: OWNER
Credential: M.D.
Phone: 910-483-4687