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General NPI Number Information
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NPI Number | 1104033414
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Entity Type | Individual
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Provider Name | RONALD MARTIN WEINTRAUB M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1943 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-1047
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Country | US
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Telephone | 617-665-3194
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Fax | 617-665-3577
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Provider Business Mailing Address
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Address Line | 975 MEMORIAL DR APT 211
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5753
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Country | US
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Telephone | 617-547-3003
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Fax | 617-547-3113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 30326
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License Number State | MA
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