DR. EILEEN S WIESENBERGER (NPI# 1609919497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609919497 |
| Entity Type | Individual |
| Full Name | DR. EILEEN S WIESENBERGER |
| Credential | DO |
| Practice Address |
6190 Georgetown Blvd Eldersburg MD 21784-6460 |
| Practice Telephone | 4105525050 |
| Mailing Telephone | 4105525050 |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2012-12-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | H0073247 | MD | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | OS 10334 | FL | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | P18479 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 000608200 | 05 |
| Street Address |
6190 GEORGETOWN BLVD |
| City | ELDERSBURG |
| State | MD |
| Zip Code | 21784-6460 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427042027 | Jill Marie Koeppen | Nurse Practitioner | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2005-09-09 |
| 1255941522 | Lifebridge Sports Medicine and Rehabilitation LLC | Clinic/Center | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2020-08-03 |
| 1033755434 | Lifebridge Sports Medicine and Rehabilitation LLC | Clinic/Center | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2019-11-20 |
| 1245892819 | Kristen Allard | Registered Nurse | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2019-07-03 |
| 1265908446 | Crystal Olivia Leonard | Nurse Practitioner | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2018-10-16 |
| 1578055497 | Lifebridge Sports Medicine and Rehabilitation LLC | Clinic/Center | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2018-06-06 |
| 1841732047 | Melissa Bassett | Nurse Practitioner | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2016-11-06 |
| 1891247003 | Lifebridge Community Physicians, Inc. | Internal Medicine | 6190 Georgetown Blvd, Suite 104, Eldersburg, MD 21784-6460 | 2016-11-04 |
| 1730539289 | Jay Steven Orr | Family Medicine | 6190 Georgetown Blvd, Eldersburg, MD 21784 | 2016-06-15 |
| 1649662776 | Genna Sellers | Nurse Practitioner | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2015-02-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033681085 | Kathleen Busching | Occupational Therapy Assistant | Intergrace Fairhaven, 7200 Third Ave, Sykesville, MD 21784 | 2018-12-31 |
| 1619450376 | Mackenzie Fleming | Counselor | 6220 Georgetown Blvd Suite C, Eldersburg, MD 21784 | 2018-09-10 |
| 1316426919 | Rebecca Rubin | Nurse Practitioner | 1380 Progress Way, Suite 102, Eldersburg, MD 21784 | 2018-08-14 |
| 1417473273 | Andrey Doroshenko | Dentist | 1722 Underwood Road, Sykesville, MD 21784 | 2017-08-14 |
| 1992229694 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 6400 Georgetown Blvd, Eldersburg, MD 21784 | 2017-08-03 |
| 1457894495 | Bethany Six | Nurse Practitioner | 6190 Gerogetown Blvd, Eldersburg, MD 21784 | 2016-11-23 |
| 1982011821 | Fast Track Urgent Care, LLC | Clinic/Center | 1315 Breton Drive, Eldersburg, MD 21784 | 2014-07-11 |
| 1588097984 | Centers for Advanced Orthopaedics, LLC | Orthopaedic Surgery | 5961 Exchange Dr, Suite 100, Eldersburg, MD 21784 | 2013-08-21 |
| 1356690986 | Kayla Nicole Koster | Speech-Language Pathologist | 1702 Liberty Road, First Floor, Sykesville, MD 21784 | 2012-08-29 |
| 1558645663 | Fusion Dental | Dentist | 5959 Exchange Drive, Suite 116, Eldersburg, MD 21784 | 2011-10-07 |
| Find all providers in zip 21784 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780790253 | Ana Idelca Sarante | Internal Medicine | 1645 Liberty Rd Ste 204, Eldersburg, MD 21784-6542 | 2006-08-21 |
| 1891247003 | Lifebridge Community Physicians, Inc. | Internal Medicine | 6190 Georgetown Blvd, Suite 104, Eldersburg, MD 21784-6460 | 2016-11-04 |
| 1902161847 | Lifebridge Community Physicians, Inc | Internal Medicine | 1645 Liberty Rd, Suite 204, Eldersburg, MD 21784-6521 | 2012-07-06 |
| 1386754455 | William George Tan | Internal Medicine | 1645 Liberty Rd, Eldersburg, MD 21784-6521 | 2006-08-30 |
| 1578574422 | Ellis Mez, Md, Pa | Internal Medicine | 1645 Liberty Rd, Suite 204, Eldersburg, MD 21784-6521 | 2006-08-10 |
| 1023029956 | Ellis Mez | Internal Medicine | 1645 Liberty Rd, Suite 204, Eldersburg, MD 21784-6521 | 2006-08-09 |
| 1851310759 | Betty Yu-wah Wang | Internal Medicine | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2006-07-19 |
| 1821027822 | Karen Merritt | Internal Medicine | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2006-07-02 |
| 1962449942 | Nicholas John Kohlerman IIi | Internal Medicine | 6190 Georgetown Blvd, Eldersburg, MD 21784-6460 | 2006-05-31 |
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|---|---|---|---|---|
| 1114528353 | Barry Whitcomb Wolcott | Internal Medicine | 7353 Oskaloosa Dr, Derwood, MD 20855-2647 | 2020-11-04 |
| 1891396107 | Medacute Care LLC | Internal Medicine | 313 Skyview Dr, Cumberland, MD 21502-1929 | 2020-11-03 |
| 1689272262 | Marsha Seidelman, M.d., LLC | Internal Medicine | 10301 Georgia Ave Ste 304, Silver Spring, MD 20902-5020 | 2020-10-15 |
| 1770190647 | Medical Maryland Star Choice LLC | Internal Medicine | 2308 Pot Spring Rd, Luthvle Timon, MD 21093-2726 | 2020-09-25 |
| 1538774609 | Benchmark Medical LLC | Internal Medicine | 904 Stags Head Rd, Towson, MD 21286-1459 | 2020-09-15 |
| 1760090294 | Outreach Recovery II, LLC | Internal Medicine | 339 E Antietam St Ste 4, Hagerstown, MD 21740-5767 | 2020-07-21 |
| 1699398008 | Tb Medical | Internal Medicine | 10753 Falls Rd Ste 225, Lutherville, MD 21093-4597 | 2020-05-20 |
| 1073136693 | Bernard Willis Parker | Internal Medicine | 15239 Briarcliff Manor Way, Burtonsville, MD 20866-1662 | 2020-05-19 |
| 1134742695 | Dura Internal Medicine Limited Liability Company | Internal Medicine | 15225 Shady Grove Rd Ste 103, Rockville, MD 20850-3252 | 2020-05-19 |
| 1457973026 | Zeus Primary Care Associates LLC | Internal Medicine | 4701 Randolph Rd Ste 209a, Rockville, MD 20852-2257 | 2020-05-17 |
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| City | ELDERSBURG |
| Zip Code | 21784 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.