Provider Demographics
NPI:1346243920
Name:WEINER, JAY H (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10605 CONCORD ST
Mailing Address - Street 2:STE 500
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2504
Mailing Address - Country:US
Mailing Address - Phone:301-942-2977
Mailing Address - Fax:301-942-8031
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:STE.213
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-942-2977
Practice Address - Fax:301-942-8031
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-11-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2007-10-03
Provider Licenses
StateLicense IDTaxonomies
MDD24571207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62509Medicare UPIN