Provider Demographics
NPI:1164934881
Name:WISECARE PRIMARY CARE
Entity Type:Organization
Organization Name:WISECARE PRIMARY CARE
Other - Org Name:WISECARE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-255-7900
Mailing Address - Street 1:33 MAGOTHY BEACH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4465
Mailing Address - Country:US
Mailing Address - Phone:410-255-7900
Mailing Address - Fax:
Practice Address - Street 1:485 RITCHIE HWY STE 102
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2918
Practice Address - Country:US
Practice Address - Phone:410-255-7900
Practice Address - Fax:410-255-7300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WISECARE PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty