Provider Demographics
NPI:1922073386
Name:WEISMAN, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-912-5831
Mailing Address - Fax:410-630-7685
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-912-5831
Practice Address - Fax:410-630-7685
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101224138207R00000X
MDD85980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11423Medicare UPIN
110007666Medicare ID - Type Unspecified