Provider Demographics
NPI:1659367829
Name:WEIDNER, JOSEPH KERN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KERN
Last Name:WEIDNER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 COLONIAL WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2283
Mailing Address - Country:US
Mailing Address - Phone:410-658-6696
Mailing Address - Fax:410-658-4548
Practice Address - Street 1:101 COLONIAL WAY
Practice Address - Street 2:SUITE A
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2283
Practice Address - Country:US
Practice Address - Phone:410-658-6696
Practice Address - Fax:410-658-4548
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-11-16
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Provider Licenses
StateLicense IDTaxonomies
MDD44373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F67615Medicare UPIN
MD278M373FMedicare PIN