Healthcare Provider Details

I. General information

NPI: 1174394951
Provider Name (Legal Business Name): MEDSTAR HEALTH WEIGHT MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BENFIELD BLVD STE 250
MILLERSVILLE MD
21108-3005
US

IV. Provider business mailing address

1099 WINTERSON RD STE 300
LINTHICUM HEIGHTS MD
21090-2279
US

V. Phone/Fax

Practice location:
  • Phone: 410-975-5447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RONDA RICHERT
Title or Position: VP REVENUE CYCLE OPERATIONS
Credential:
Phone: 800-905-3261