Healthcare Provider Details

I. General information

NPI: 1407943475
Provider Name (Legal Business Name): DENNIS M. WEBER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 ROCKVILLE PIKE SUITE 105
ROCKVILLE MD
20852-2734
US

IV. Provider business mailing address

11801 ROCKVILLE PIKE SUITE 105
ROCKVILLE MD
20852-2734
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-6222
  • Fax: 301-881-1639
Mailing address:
  • Phone: 301-881-6222
  • Fax: 301-881-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number00364
License Number StateMD

VIII. Authorized Official

Name: DR. DENNIS MITCHELL WEBER
Title or Position: DIRECTOR/OWNER
Credential: DPM
Phone: 301-881-6222