Provider Demographics
NPI:1285626044
Name:WEISBROT, ERIC L (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:WEISBROT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 N CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3823
Mailing Address - Country:US
Mailing Address - Phone:410-637-8255
Mailing Address - Fax:410-637-8277
Practice Address - Street 1:1021 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3823
Practice Address - Country:US
Practice Address - Phone:410-637-8255
Practice Address - Fax:410-637-8277
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD332600400Medicaid
MD332600400Medicaid
MD627M118FMedicare ID - Type Unspecified