Healthcare Provider Details

I. General information

NPI: 1417324799
Provider Name (Legal Business Name): ROBERT WEINMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SLATER ST
OTTAWA ON
K1A0K9
CA

IV. Provider business mailing address

400 STEWART STREET APT 1603
OTTAWA ONTARIO
K1N6L2
CA

V. Phone/Fax

Practice location:
  • Phone: 613-948-4714
  • Fax:
Mailing address:
  • Phone: 613-884-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number49976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: