Healthcare Provider Details

I. General information

NPI: 1104993625
Provider Name (Legal Business Name): JOHN T ZWEIG EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 MT HERMON ROAD SUITE 3A
SALISBURY MD
21804
US

IV. Provider business mailing address

1323 MT HERMON ROAD SUITE 3A
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-8844
  • Fax: 410-749-1809
Mailing address:
  • Phone: 410-543-8844
  • Fax: 410-749-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1668
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: