Healthcare Provider Details

I. General information

NPI: 1508854498
Provider Name (Legal Business Name): IAN M WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DR SUITE 300
BALTIMORE MD
21209-2230
US

IV. Provider business mailing address

2700 QUARRY LAKE DR SUITE 300
BALTIMORE MD
21209-2230
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-8900
  • Fax: 410-377-3156
Mailing address:
  • Phone: 410-377-8900
  • Fax: 410-377-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberD42882
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: