Healthcare Provider Details

I. General information

NPI: 1003740630
Provider Name (Legal Business Name): ERIN FAY WEIDMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 FREDERICK RD
CATONSVILLE MD
21228-4625
US

IV. Provider business mailing address

509 ISAAC RUSSELL ST
NEW MARKET MD
21774-6569
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-1116
  • Fax:
Mailing address:
  • Phone: 240-422-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5816
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: