Provider Demographics
NPI:1124247853
Name:DAVID H. WEINGOLD, M.D., P.A.
Entity type:Organization
Organization Name:DAVID H. WEINGOLD, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE REP.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEBA
Authorized Official - Middle Name:O
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-802-3376
Mailing Address - Street 1:4334 E HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6621
Mailing Address - Country:US
Mailing Address - Phone:870-802-3376
Mailing Address - Fax:
Practice Address - Street 1:4334 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6621
Practice Address - Country:US
Practice Address - Phone:870-802-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130967001Medicaid
AR70013929OtherRAILROAD MEDICARE
AR138940002Medicaid
AR70013929OtherRAILROAD MEDICARE
ARE80102Medicare UPIN