Provider Demographics
NPI:1528066529
Name:WEISBURGH, MICHAEL NEIL (PHARMD, BCPS, BCPP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NEIL
Last Name:WEISBURGH
Suffix:
Gender:M
Credentials:PHARMD, BCPS, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 CANNONCADE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4106
Mailing Address - Country:US
Mailing Address - Phone:410-286-9118
Mailing Address - Fax:
Practice Address - Street 1:21676 GREAT MILLS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-3806
Practice Address - Country:US
Practice Address - Phone:301-863-5631
Practice Address - Fax:301-863-7462
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16582183500000X, 1835N1003X, 1835P1300X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric