Provider Demographics
NPI:1194786624
Name:MU, WEITONG (MD, PHD)
Entity type:Individual
Prefix:
First Name:WEITONG
Middle Name:
Last Name:MU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WALTER WARD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1283
Mailing Address - Country:US
Mailing Address - Phone:443-643-4700
Mailing Address - Fax:443-643-4707
Practice Address - Street 1:100 WALTER WARD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1283
Practice Address - Country:US
Practice Address - Phone:443-643-4700
Practice Address - Fax:443-643-4707
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062070207RG0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412133300Medicaid