Provider Demographics
NPI:1790812808
Name:ERIC L. WEISBROT, M.D., P.A.
Entity Type:Organization
Organization Name:ERIC L. WEISBROT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISBROT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-637-8255
Mailing Address - Street 1:1021 N CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3823
Mailing Address - Country:US
Mailing Address - Phone:410-637-8255
Mailing Address - Fax:410-637-8277
Practice Address - Street 1:1021 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3823
Practice Address - Country:US
Practice Address - Phone:410-637-8255
Practice Address - Fax:410-637-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021487261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care