Provider Demographics
NPI:1508854498
Name:WEINER, IAN M (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:M
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 QUARRY LAKE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2230
Mailing Address - Country:US
Mailing Address - Phone:410-377-8900
Mailing Address - Fax:410-377-3156
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2230
Practice Address - Country:US
Practice Address - Phone:410-377-8900
Practice Address - Fax:410-377-3156
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD42882207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD342461800Medicaid
MD838 LMedicare ID - Type Unspecified