Provider Demographics
NPI:1558872374
Name:WISECARE PRIMARY CARE
Entity Type:Organization
Organization Name:WISECARE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-252-7220
Mailing Address - Street 1:33 MAGOTHY BEACH RD STE 102-103
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4413
Mailing Address - Country:US
Mailing Address - Phone:410-255-7922
Mailing Address - Fax:410-255-7300
Practice Address - Street 1:33 MAGOTHY BEACH RD STE 102-103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4413
Practice Address - Country:US
Practice Address - Phone:410-255-7922
Practice Address - Fax:410-255-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBW7859335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty