Healthcare Provider Details

I. General information

NPI: 1457301822
Provider Name (Legal Business Name): GREGG D WEINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 WILLOW LAWN DR STE 117
RICHMOND VA
23230-3421
US

IV. Provider business mailing address

1508 WILLOW LAWN DR STE 117
RICHMOND VA
23230-3421
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-8102
  • Fax: 804-282-3744
Mailing address:
  • Phone: 804-288-8102
  • Fax: 804-282-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101058262
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101058262
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: