Provider Demographics
NPI:1215117767
Name:JOSEPH K. WEIDNER JR MD LLC
Entity type:Organization
Organization Name:JOSEPH K. WEIDNER JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEIDNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-658-6696
Mailing Address - Street 1:101 COLONIAL WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2272
Mailing Address - Country:US
Mailing Address - Phone:410-658-6696
Mailing Address - Fax:410-658-4548
Practice Address - Street 1:101 COLONIAL WAY
Practice Address - Street 2:SUITE A
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2272
Practice Address - Country:US
Practice Address - Phone:410-658-6696
Practice Address - Fax:410-658-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD278MMedicare PIN