Provider Demographics
NPI:1992099865
Name:WEISZ, JESSICA R (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:WEISZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:STE 1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:240-499-2636
Mailing Address - Fax:240-499-2602
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:301-431-2972
Practice Address - Fax:301-439-0008
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2015-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0079166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program