Basic Information
Provider Information
NPI: 1073019741
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEINGART
FirstName: MELANIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 51 N 39TH ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191042640
CountryCode: US
TelephoneNumber: 2156629990
FaxNumber: 2152433297
Practice Location
Address1: 51 N 39TH ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191042640
CountryCode: US
TelephoneNumber: 2156629990
FaxNumber: 2152433297
Other Information
ProviderEnumerationDate: 04/02/2018
LastUpdateDate: 11/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD473054PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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