Provider Demographics
NPI:1447594692
Name:WEISBERG, MIRYAM
Entity type:Individual
Prefix:MRS
First Name:MIRYAM
Middle Name:
Last Name:WEISBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY BRIDGET
Other - Middle Name:
Other - Last Name:WEISBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11506 LOCKHART PL
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3165
Mailing Address - Country:US
Mailing Address - Phone:301-906-6162
Mailing Address - Fax:
Practice Address - Street 1:11506 LOCKHART PL
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3165
Practice Address - Country:US
Practice Address - Phone:301-906-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula