Healthcare Provider Details

I. General information

NPI: 1902819311
Provider Name (Legal Business Name): DANIEL WEINSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 COLLEGE PKWY
COLCHESTER VT
05446-3007
US

IV. Provider business mailing address

PO BOX 1063 FAHC
BURLINGTON VT
05402
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1170
  • Fax:
Mailing address:
  • Phone: 802-434-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420010549
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number042-0010549
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: