Healthcare Provider Details

I. General information

NPI: 1386884302
Provider Name (Legal Business Name): ELIZABETH KRISTINE WEIHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST # 3142
BALTIMORE MD
21287-7406
US

IV. Provider business mailing address

PO BOX 64358
BALTIMORE MD
21264-4358
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6500
  • Fax:
Mailing address:
  • Phone: 410-955-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM9088
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD71516
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: