Provider Demographics
NPI:1538317292
Name:WEIMAR-FITZPATRICK, JEANNINE A (MD)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:A
Last Name:WEIMAR-FITZPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:610-387-4520
Mailing Address - Fax:
Practice Address - Street 1:100 MARIS GROVE WAY
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1282
Practice Address - Country:US
Practice Address - Phone:610-387-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD434579OtherPA MEDICAL LICENSE
PAMLHC ASSIGNMENT ACCTOther440771