Individual
THEODORE LESLIE DEWEESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-8964
Mailing address
PO BOX 64474, BALTIMORE, MD 21264-4474
(410) 614-3979
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
D14152
MD
2085R0001X
Radiation Oncology Physician
D47485
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376561000
—
MD
Enumeration date
06/17/2006
Last updated
01/17/2014
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