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General NPI Number Information
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NPI Number | 1053304329
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Entity Type | Individual
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Provider Name | JEREMY PAUL WEINER MD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5601 LOCH RAVEN BLVD POB #100
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City | BALTIMORE
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State | MD
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Zip | 21239-2905
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Country | US
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Telephone | 410-323-9210
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Fax | 410-323-9525
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Provider Business Mailing Address
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Address Line | 2400 VELVET RIDGE DR
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3030
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Country | US
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Telephone | 410-323-9210
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Fax | 410-323-9525
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0032984
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License Number State | MD
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