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NPI Code Detail

MEDICARE: DR. RICHARD MARK WEINBERGER SR. MSED, LP

MEDICARE: DR. RICHARD MARK WEINBERGER SR. MSED, LP
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
1103TC0700XClinical PsychologistLP1310MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1380248500OTHERMNMEDICAL ASSISTANCE

General Provider Information

NPI Number : 1730280306
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD MARK WEINBERGER SR. MSED, LP
Provider Business Mailing Address
First Line : 4240 PARK GLEN RD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-5427
Country : US
Telephone Number : 612-925-6033
Fax Number : 612-925-8496
Provider Business Practice Location Address
First Line : 4027 COUNTY ROAD 25
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-2629
Country : US
Telephone Number : 612-925-6033
Fax Number : 612-925-8496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 01/25/2022

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