Healthcare Provider Details

I. General information

NPI: 1821265505
Provider Name (Legal Business Name): JEREMEY LEONARD WEISS OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BELMAWR PL
MILLERSVILLE MD
21108-1561
US

IV. Provider business mailing address

555 BELMAWR PL
MILLERSVILLE MD
21108-1561
US

V. Phone/Fax

Practice location:
  • Phone: 443-224-7403
  • Fax:
Mailing address:
  • Phone: 443-224-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberN/A
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0162268
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: