Provider Demographics
NPI:1063577294
Name:WEINSTEIN, EDWARD ALAN (MD, PHD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALAN
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E MONUMENT ST
Mailing Address - Street 2:ROOM 457
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0020
Mailing Address - Country:US
Mailing Address - Phone:410-502-2326
Mailing Address - Fax:410-955-7889
Practice Address - Street 1:1830 E MONUMENT ST
Practice Address - Street 2:ROOM 457
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0020
Practice Address - Country:US
Practice Address - Phone:410-502-2326
Practice Address - Fax:410-955-7889
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine