Basic Information
| Provider Information | |||||||||
| NPI: | 1770647992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEINSTEIN | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 CONCORD TERRACE | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002433839 | ||||||||
| FaxNumber: | 9548580404 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 JOHNSON FERRY RD NE | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042552057 | ||||||||
| FaxNumber: | 4042564238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 07/01/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 47551 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00842311A | 05 | GA | MEDICAID | 702250 | 01 | GA | BCBS PIN NUMBER | OTHER | 00842311B | 05 | GA | MEDICAID | 4585000 | 01 | GA | AETNA PROV NUMBER | OTHER |