Individual
MARK H WEIDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 BROAD STREET PLZ, BROAD STREET MEDICAL GROUP, GLENS FALLS, NY 12801-4363
(518) 926-1770
(518) 926-1799
Mailing address
PO BOX 304, GLENS FALLS, NY 12801-0304
(518) 926-1770
(518) 926-1799
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
210870
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01609810
—
NY
05
—
0VN1263
—
VT
01
—
RB8388
MEDICARE
NY
Enumeration date
11/01/2006
Last updated
06/08/2009
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