Provider Demographics
NPI:1093310450
Name:WEEKEND WHITECOAT CONCIERGE LLC
Entity Type:Organization
Organization Name:WEEKEND WHITECOAT CONCIERGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEO
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-999-1742
Mailing Address - Street 1:1034 MCDONOGH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1110
Mailing Address - Country:US
Mailing Address - Phone:410-999-1742
Mailing Address - Fax:410-999-1742
Practice Address - Street 1:1034 MCDONOGH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1110
Practice Address - Country:US
Practice Address - Phone:410-999-1742
Practice Address - Fax:410-999-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty