Provider Demographics
NPI:1902162332
Name:WEINGARTEN, SETH MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:MARK
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9255 DOHENY RD
Mailing Address - Street 2:1502
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3201
Mailing Address - Country:US
Mailing Address - Phone:310-614-9200
Mailing Address - Fax:310-274-0966
Practice Address - Street 1:9255 DOHENY RD
Practice Address - Street 2:1502
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3201
Practice Address - Country:US
Practice Address - Phone:310-614-9200
Practice Address - Fax:310-274-0966
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAGFE11935174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGFE11935OtherMEDICAL BOARD OF CALIFORNIA