Provider Demographics
NPI:1417043217
Name:WEIDNER, THOMAS F (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:WEIDNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13218 EXECUTIVE PARK TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2641
Mailing Address - Country:US
Mailing Address - Phone:301-251-6226
Mailing Address - Fax:240-361-2886
Practice Address - Street 1:13218 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2641
Practice Address - Country:US
Practice Address - Phone:301-251-6226
Practice Address - Fax:240-361-2886
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00574213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT30970Medicare UPIN
MD536390Medicare ID - Type Unspecified