MEDICARE: DR. MARTIN WEINBERG D.M.D.,PH.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	1223G0001X	General Practice Dentistry	018880	PA

General Provider Information

NPI Number	:	1942349782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN WEINBERG D.M.D.,PH.D.

Provider Business Mailing Address
First Line	:	401 OAKWYNNE DR
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-2304
Country	:	US
Telephone Number	:	610-649-4192
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 WALNUT ST
Second Line	:	SUITE1101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3419
Country	:	US
Telephone Number	:	215-732-0505
Fax Number	:	215-732-8744

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	11/18/2010

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