Provider Demographics
NPI:1902869563
Name:WEINER, ELAINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:E
Last Name:WEINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 KEN OAK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4309
Mailing Address - Country:US
Mailing Address - Phone:410-466-8286
Mailing Address - Fax:
Practice Address - Street 1:SPRING GROVE HOSPITAL GROUNDS
Practice Address - Street 2:MAPLE AND LOCUST STREETS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-402-7694
Practice Address - Fax:410-402-7198
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD386492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD056691800Medicaid
MD100WMedicare ID - Type Unspecified
MD056691800Medicaid