Healthcare Provider Details

I. General information

NPI: 1487815635
Provider Name (Legal Business Name): NATHAN WEI, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 THOMAS JOHNSON DR
FREDERICK MD
21702-4301
US

IV. Provider business mailing address

71 THOMAS JOHNSON DR
FREDERICK MD
21702-4301
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-1160
  • Fax:
Mailing address:
  • Phone: 301-624-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1263
License Number StateMD

VIII. Authorized Official

Name: DR. NATHAN WEI, MD, PA
Title or Position: CEO
Credential:
Phone: 301-624-1160