Provider Demographics
NPI:1679743512
Name:THOMAS F WEIDNER DPM CHARTERED
Entity type:Organization
Organization Name:THOMAS F WEIDNER DPM CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:WEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-251-6226
Mailing Address - Street 1:13218 EXECUTIVE PARK TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2641
Mailing Address - Country:US
Mailing Address - Phone:301-251-6226
Mailing Address - Fax:240-361-2886
Practice Address - Street 1:13218 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2641
Practice Address - Country:US
Practice Address - Phone:301-251-6226
Practice Address - Fax:240-361-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00574332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4506200001Medicare NSC
DC536390Medicare PIN
MDT30970Medicare UPIN