1134172547 NPI number — KARL E WEINGARTEN MD

Table of content: KARL E WEINGARTEN MD (NPI 1134172547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134172547 NPI number — KARL E WEINGARTEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINGARTEN
Provider First Name:
KARL
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134172547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412805
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-2805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-8900
Provider Business Mailing Address Fax Number:
484-924-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12555 GARDEN GROVE BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92843-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-534-1680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  G80449 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 059669 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: G80449 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 52679668 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 720877274E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G59669 . This is a "SC CAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 720877274A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 720877274B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G804490 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 720877274C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 720877274D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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