Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D41983 | MD |
NPI | 1063454536 |
---|---|
Provider Name | Jon Weingart |
First Address | Baltimore, MD 21264-4286 |
Second Address | Lutherville, MD 21093-4515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 20/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108921800 | (05) | MD |
F56723 | (02) | MD |