Basic Information
| Provider Information | |||||||||
| NPI: | 1659367829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEIDNER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | KERN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 COLONIAL WAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219112283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106586696 | ||||||||
| FaxNumber: | 4106584548 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 COLONIAL WAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219112283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106586696 | ||||||||
| FaxNumber: | 4106584548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 11/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D44373 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.