Healthcare Provider Details

I. General information

NPI: 1912902412
Provider Name (Legal Business Name): MAX WEISFELD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 HARFORD RD
BALTIMORE MD
21214-2231
US

IV. Provider business mailing address

5508 HARFORD RD
BALTIMORE MD
21214-2231
US

V. Phone/Fax

Practice location:
  • Phone: 410-426-5508
  • Fax: 410-426-4066
Mailing address:
  • Phone: 410-426-5508
  • Fax: 410-426-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00400
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: