1609937564 NPI number — DR. JOHN HEBNER WEIGEL MD

Table of content: DR. JOHN HEBNER WEIGEL MD (NPI 1609937564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609937564 NPI number — DR. JOHN HEBNER WEIGEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIGEL
Provider First Name:
JOHN
Provider Middle Name:
HEBNER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1609937564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 PRINCE FREDERICK BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-3492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-535-2005
Provider Business Mailing Address Fax Number:
410-535-4850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
985 N. PRINCE FREDERICK BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-3492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-535-2005
Provider Business Practice Location Address Fax Number:
410-535-4850
Provider Enumeration Date:
12/13/2006

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: 207R00000X , with the licence number:  D26358 , 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)

  • Identifier: 110032504 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 326961200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2148224 . This is a "AETNA PCP HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 836795 . This is a "OPTIMUM CH-MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 42249801 . This is a "CAREFIRST OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4461101 . This is a "AETNA NON HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C0410007 . This is a "CAREFIRST OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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