Healthcare Provider Details

I. General information

NPI: 1083618870
Provider Name (Legal Business Name): BRUCE WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MAIN ST MOB II STE 203
PHOENIXVILLE PA
19460-4459
US

IV. Provider business mailing address

826 MAIN ST MOB II STE 203
PHOENIXVILLE PA
19460-4459
US

V. Phone/Fax

Practice location:
  • Phone: 610-983-1980
  • Fax: 610-422-5435
Mailing address:
  • Phone: 610-983-1980
  • Fax: 610-422-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD037122E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: