Provider Demographics
NPI:1134172547
Name:WEINGARTEN, KARL E (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:E
Last Name:WEINGARTEN
Suffix:
Gender:M
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:PO BOX 412805
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2805
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:12555 GARDEN GROVE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1904
Practice Address - Country:US
Practice Address - Phone:714-534-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG804492085R0202X, 2085R0204X
GA0596692085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52679668OtherBCBS
GA720877274EMedicaid
G59669OtherSC CAID
GA720877274AMedicaid
GA720877274BMedicaid
CA00G804490Medicaid
GA720877274CMedicaid
GA720877274DMedicaid
GA720877274CMedicaid
CAWG80449GMedicare PIN
GA720877274AMedicaid
CAWG80449HMedicare PIN