Healthcare Provider Details

I. General information

NPI: 1346243920
Provider Name (Legal Business Name): JAY H WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 10/03/2007

III. Provider practice location address

16220 FREDERICK RD STE.213
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

10605 CONCORD ST STE 500
KENSINGTON MD
20895-2504
US

V. Phone/Fax

Practice location:
  • Phone: 301-942-2977
  • Fax: 301-942-8031
Mailing address:
  • Phone: 301-942-2977
  • Fax: 301-942-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD24571
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: