Provider Demographics
NPI:1063574515
Name:WEBER, JASON MEADE (DPM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MEADE
Last Name:WEBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 RUSSELL AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2606
Mailing Address - Country:US
Mailing Address - Phone:301-948-3668
Mailing Address - Fax:301-926-7787
Practice Address - Street 1:702 RUSSELL AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2606
Practice Address - Country:US
Practice Address - Phone:301-948-3668
Practice Address - Fax:301-926-7787
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01365213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409152300Medicaid
DC018179D98Medicare PIN
U80593Medicare UPIN
DCP00428978Medicare PIN