Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101253875 | VA |
N | 111NI0900X | Internist | 0101253875 | VA |
Y | 207R00000X | Internist | D75548 | MD |
Y | 111NI0900X | Internist | D75548 | MD |
N | 207R00000X | Internist | MD041211 | DC |
N | 111NI0900X | Internist | MD041211 | DC |
NPI | 1003133299 |
---|---|
Provider Name | Shoshana Jo Weiner |
First Address | Baltimore, MD 21264-4442 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 04/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S062-0600 | CAREFIRST BC/BS (01) | MD |