Provider Demographics
NPI:1124053350
Name:WEICHEL, ERIC DAVID (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:WEICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7501 GREENWAY CENTER DR.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1211
Mailing Address - Country:US
Mailing Address - Phone:301-474-4679
Mailing Address - Fax:301-474-7182
Practice Address - Street 1:16901 MELFORD BLVD. #111
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:301-805-5395
Practice Address - Fax:301-805-5396
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037765207W00000X, 207WX0107X
MDD0068533207W00000X, 207WX0107X
VA0101244791207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC076060900Medicaid
MD020939200Medicaid
MD020939200Medicaid