Provider Demographics
NPI:1336264985
Name:MAX WEISFELD, DPM, PA
Entity type:Organization
Organization Name:MAX WEISFELD, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-426-5508
Mailing Address - Street 1:5508 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2231
Mailing Address - Country:US
Mailing Address - Phone:410-426-5508
Mailing Address - Fax:410-426-4066
Practice Address - Street 1:5508 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2231
Practice Address - Country:US
Practice Address - Phone:410-426-5508
Practice Address - Fax:410-426-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1037261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1851574255Medicare NSC
MDT59488Medicare UPIN
MDZZ72Medicare PIN
MDMW6OtherBLUE CHOICE