Healthcare Provider Details

I. General information

NPI: 1558364604
Provider Name (Legal Business Name): MARC S WEINBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARC S WEINBERG M.D.

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ STE 304
PROVIDENCE RI
02904-2773
US

IV. Provider business mailing address

82 TALBOT WAY
SEEKONK MA
02771-2802
US

V. Phone/Fax

Practice location:
  • Phone: 401-228-3000
  • Fax: 401-649-4222
Mailing address:
  • Phone: 508-399-8332
  • Fax: 615-234-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number43058
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD05402
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRI5402
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: