Provider Demographics
NPI:1053728634
Name:WISECARE, LLC
Entity type:Organization
Organization Name:WISECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-252-7220
Mailing Address - Street 1:33 MAGOTHY BEACH RD
Mailing Address - Street 2:SUITE 102-103
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4413
Mailing Address - Country:US
Mailing Address - Phone:410-255-7900
Mailing Address - Fax:410-255-7300
Practice Address - Street 1:33 MAGOTHY BEACH RD
Practice Address - Street 2:SUITE 102-103
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-255-7900
Practice Address - Fax:410-255-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423632700Medicaid