Healthcare Provider Details

I. General information

NPI: 1720061153
Provider Name (Legal Business Name): ADAM R WEINSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC--DEPT OF PEDIATRICS
LEBANON NH
03756-0001
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC--DEPT OF PEDIATRICS
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9884
  • Fax: 603-650-0907
Mailing address:
  • Phone: 603-653-9884
  • Fax: 603-650-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14529
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number14529
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: