Provider Demographics
NPI:1972817724
Name:WEINBERGER, MEREDITH ALYSE (OD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ALYSE
Last Name:WEINBERGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHESAPEAKE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6391
Mailing Address - Country:US
Mailing Address - Phone:410-392-6133
Mailing Address - Fax:410-392-8120
Practice Address - Street 1:103 CHESAPEAKE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6391
Practice Address - Country:US
Practice Address - Phone:410-392-6133
Practice Address - Fax:410-392-8120
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2209152W00000X
DEI3-0001347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD194719Medicare PIN
MD503MMedicare PIN
DEG01069Medicare PIN
DE213410Medicare PIN