Provider Demographics
NPI:1396746640
Name:WEISMAN, RICHARD MORRIS (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MORRIS
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WEST RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2326
Mailing Address - Country:US
Mailing Address - Phone:410-796-9606
Mailing Address - Fax:410-823-3605
Practice Address - Street 1:22 WEST RD
Practice Address - Street 2:STE 101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2326
Practice Address - Country:US
Practice Address - Phone:410-823-3600
Practice Address - Fax:410-823-3605
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00172512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187801800Medicaid
157676Medicare PIN
MDBI92Medicare PIN
158156ZD2XMedicare PIN
D76387Medicare UPIN