Healthcare Provider Details

I. General information

NPI: 1932314804
Provider Name (Legal Business Name): BRADLEY CHARLES WEINBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-1913
US

IV. Provider business mailing address

5870 CRESCENT RIDGE DR
SEVEN HILLS OH
44131-2437
US

V. Phone/Fax

Practice location:
  • Phone: 216-712-6788
  • Fax: 216-712-6788
Mailing address:
  • Phone: 216-712-6788
  • Fax: 216-712-6788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-091938
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number35.091938
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: