Individual
DR. EILEEN S WIESENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6190 GEORGETOWN BLVD, ELDERSBURG, MD 21784-6460
(410) 552-5050
Mailing address
6190 GEORGETOWN BLVD, ELDERSBURG, MD 21784-6460
(410) 552-5050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H0073247
MD
207R00000X
Internal Medicine Physician
OS 10334
FL
207R00000X
Internal Medicine Physician
P18479
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000608200
—
FL
Enumeration date
02/14/2007
Last updated
12/25/2012
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