Provider Demographics
NPI:1174633937
Name:WEINSTEIN, BARRY GERALD (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:GERALD
Last Name:WEINSTEIN
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 2469
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-2469
Mailing Address - Country:US
Mailing Address - Phone:505-820-0358
Mailing Address - Fax:505-466-1257
Practice Address - Street 1:1800 OLD PECOS TRAIL
Practice Address - Street 2:STE P
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-820-0358
Practice Address - Fax:505-466-1257
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM851212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D36025Medicare UPIN
NM$$$$$$$$$Medicare PIN