Healthcare Provider Details

I. General information

NPI: 1437335320
Provider Name (Legal Business Name): CLINICAL NEUROSCIENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 LITTLE PATUXENT PKWY SUITE 209
COLUMBIA MD
21044-2896
US

IV. Provider business mailing address

4509 ROSEDALE AVE
BETHESDA MD
20814-4754
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-1928
  • Fax: 410-997-1929
Mailing address:
  • Phone: 410-997-1928
  • Fax: 410-997-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0057645
License Number StateMD

VIII. Authorized Official

Name: DR. THAIS D WEIBEL
Title or Position: OWNER
Credential: M.D.
Phone: 410-997-1928