1013999390 NPI number — EDDA NATANYA WEISSBERG PHD

Table of content: EDDA NATANYA WEISSBERG PHD (NPI 1013999390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013999390 NPI number — EDDA NATANYA WEISSBERG PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISSBERG
Provider First Name:
EDDA
Provider Middle Name:
NATANYA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013999390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 RITCHIE HWY
Provider Second Line Business Mailing Address:
STE F
Provider Business Mailing Address City Name:
ARNOLD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21012-2742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-757-2077
Provider Business Mailing Address Fax Number:
410-757-5184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 OLD SOLOMONS ISLAND RD
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-573-1944
Provider Business Practice Location Address Fax Number:
410-573-1972
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  03345 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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