1679344121 NPI number — MEDSTAR HEALTH WEIGHT MANAGEMENT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679344121 NPI number — MEDSTAR HEALTH WEIGHT MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSTAR HEALTH WEIGHT MANAGEMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679344121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1099 WINTERSON RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINTHICUM HEIGHTS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21090-2279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5022 CAMPBELL BLVD STE LM
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOTTINGHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-4969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-870-3808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEHAN
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-905-3261

Provider Taxonomy Codes

  • Taxonomy code: 133VN1201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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