MEDICARE: DR. ERIC L. WEISBROT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0021487	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285626044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC L. WEISBROT M.D.

Provider Business Mailing Address
First Line	:	1021 N CALVERT ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-3823
Country	:	US
Telephone Number	:	410-637-8255
Fax Number	:	410-637-8277

Provider Business Practice Location Address
First Line	:	1021 N CALVERT ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-3823
Country	:	US
Telephone Number	:	410-637-8255
Fax Number	:	410-637-8277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	06/05/2024

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