Basic Information
| Provider Information | |||||||||
| NPI: | 1649225822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEINER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 362 N BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502350 | ||||||||
| FaxNumber: | 5083502318 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 PLYMOUTH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HALIFAX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023381342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814222900 | ||||||||
| FaxNumber: | 7814222905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 33221 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2020505 | 05 | MA | MEDICAID |