Provider Demographics
NPI:1215969944
Name:WEINMAN, SUSAN DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:WEINMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ADELPHI AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4119
Mailing Address - Country:US
Mailing Address - Phone:401-331-1946
Mailing Address - Fax:401-273-9456
Practice Address - Street 1:17 ADELPHI AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4119
Practice Address - Country:US
Practice Address - Phone:401-451-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI99112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG17288Medicare UPIN