Doctor Name: | BRENT WEINERMAN |
NPI Number: | 1568476257 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | OS004236L |
Business Practice Address: | 897 Bridge St Phila, PA - 191241724 |
Business Phone Number: | 2152887000 |
Business Fax Number: | 2152887917 |
Mailing Address: | 897 Bridge St, PHILADELPHIA |
State: | PA |
Postal Code: | 191241724 |
Phone Number: | 2152887222 |
Fax Number: | 2152887917 |
NPI Enumeration Date: | 07/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | OS004236L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |