Healthcare Provider Details

I. General information

NPI: 1972721157
Provider Name (Legal Business Name): LEWIS R. WEINER, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DAVOL SQ #304
PROVIDENCE RI
02903-4755
US

IV. Provider business mailing address

1 DAVOL SQ #304
PROVIDENCE RI
02903-4755
US

V. Phone/Fax

Practice location:
  • Phone: 401-369-7070
  • Fax: 401-369-7080
Mailing address:
  • Phone: 401-369-7070
  • Fax: 401-369-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number07384
License Number StateRI

VIII. Authorized Official

Name: DR. LEWIS R. WEINER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-369-7070