Provider Demographics
NPI:1629031828
Name:WEISHAAR, KATHY JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:JANE
Last Name:WEISHAAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2781 CRYSTAL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-3000
Mailing Address - Country:US
Mailing Address - Phone:410-259-0679
Mailing Address - Fax:240-566-4755
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:240-566-4722
Practice Address - Fax:240-566-4755
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0062975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407945100Medicaid
MDI28026Medicare UPIN