Provider Demographics
NPI:1902330848
Name:WEINTRAUB, MATTHEW SCOTT (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SCOTT
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 MILSTEAD RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3835
Mailing Address - Country:US
Mailing Address - Phone:770-483-2291
Mailing Address - Fax:770-483-2927
Practice Address - Street 1:1567 MILSTEAD RD NE STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3835
Practice Address - Country:US
Practice Address - Phone:770-483-2291
Practice Address - Fax:770-483-2927
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001445213ES0103X
NJ25MD00355900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery