Provider Demographics
NPI:1407943475
Name:DENNIS M. WEBER
Entity Type:Organization
Organization Name:DENNIS M. WEBER
Other - Org Name:MD. OUTPATIENT FOOT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-881-6222
Mailing Address - Street 1:11801 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2734
Mailing Address - Country:US
Mailing Address - Phone:301-881-6222
Mailing Address - Fax:301-881-1639
Practice Address - Street 1:11801 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2734
Practice Address - Country:US
Practice Address - Phone:301-881-6222
Practice Address - Fax:301-881-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00364261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNE2OtherCAREFIRST BC/BS
MDT31158Medicare UPIN
MD409969Medicare PIN
MD1134330001Medicare NSC