Provider Demographics
NPI:1417276015
Name:WEISS, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:STE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-997-7979
Mailing Address - Fax:410-997-9231
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:STE 400
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-997-7979
Practice Address - Fax:410-997-9231
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD80948207RC0000X
PAMT196840390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD509672YCQXMedicare PIN