MEDICARE: DR. DAVID LAWRENCE WEINBERG MD

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	207N00000X	Dermatology Physician	C294911	CA

General Provider Information

NPI Number	:	1679566608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LAWRENCE WEINBERG MD

Provider Business Mailing Address
First Line	:	1405 BLACK MOUNTAIN RD
Second Line	:
City	:	HILLSBOROUGH
State	:	CA
Zip	:	94010-7122
Country	:	US
Telephone Number	:	650-344-8633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 BLACK MOUNTAIN RD
Second Line	:
City	:	HILLSBOROUGH
State	:	CA
Zip	:	94010-7122
Country	:	US
Telephone Number	:	650-344-8633
Fax Number	:

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/08/2007

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