Provider Demographics
NPI:1376668921
Name:MAX WEISFELD, DPM, PA
Entity Type:Organization
Organization Name:MAX WEISFELD, DPM, PA
Other - Org Name:JOPPA FOOT CARE AMBULATORY SURGICAL NCENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-882-5100
Mailing Address - Street 1:2316 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2808
Mailing Address - Country:US
Mailing Address - Phone:410-882-5100
Mailing Address - Fax:410-665-1510
Practice Address - Street 1:2316 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2808
Practice Address - Country:US
Practice Address - Phone:410-882-5100
Practice Address - Fax:410-665-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMW6OtherBLUE CHOICE
MDZZ72OtherMEDICARE
MD246578OtherUHC,MAMSI,MAPSI ETC
MD490004729OtherRAILROAD MEDICARE
MD027UOtherBCBS PROVIDER NUMBER
MD027UOtherBCBS PROVIDER NUMBER