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General NPI Number Information
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NPI Number | 1598369134
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Entity Type | Organization
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Legal Business Name | CLINICA MEDICINA PRIMARIA DE RISING SUN
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 101 COLONIAL WAY STE A
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City | RISING SUN
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State | MD
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Zip | 21911-2272
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Country | US
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Telephone | 443-350-0989
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Fax |
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Provider Business Mailing Address
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Address Line | 101 COLONIAL WAY STE A
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City | RISING SUN
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State | MD
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Zip | 21911-2272
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Country | US
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Telephone | 443-350-0989
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH K. WEIDNER JR.
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Credential | MD
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Telephone | 443-350-0989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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