Healthcare Provider Details

I. General information

NPI: 1982808697
Provider Name (Legal Business Name): STANLEY JOHN WEINBERGER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STAN WEINBERGER

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST UNIVERSITY PEDIATRICS, ARNOLD 3, UHC
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST UNIVERSITY PEDIATRICS, ARNOLD 3, UHC
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4696
  • Fax:
Mailing address:
  • Phone: 802-847-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0012002
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: