Provider Demographics
NPI:1598369134
Name:CLINICA MEDICINA PRIMARIA DE RISING SUN
Entity Type:Organization
Organization Name:CLINICA MEDICINA PRIMARIA DE RISING SUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEIDNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:443-350-0989
Mailing Address - Street 1:101 COLONIAL WAY STE A
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2272
Mailing Address - Country:US
Mailing Address - Phone:443-350-0989
Mailing Address - Fax:
Practice Address - Street 1:101 COLONIAL WAY STE A
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2272
Practice Address - Country:US
Practice Address - Phone:443-350-0989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care