Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D42882 | MD |
NPI | 1508854498 |
---|---|
Provider Name | Ian M Weiner |
First Address | Baltimore, MD 21209-2230 |
Second Address | Baltimore, MD 21209-2230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 17/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
342461800 | (05) | MD |
F 88372 | (02) |