MEDICARE: SAMUEL WEINER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA07739900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346220555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL WEINER M.D.

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	856-355-0340
Fax Number	:	856-355-0330

Provider Business Practice Location Address
First Line	:	141 ROUTE 70 E STE E
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-1855
Country	:	US
Telephone Number	:	856-985-7373
Fax Number	:	856-985-9611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	03/17/2022

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Directions to “ SAMUEL WEINER M.D.” Practice Location

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