Basic Information
Provider Information
NPI: 1730161522
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERGER-WEISS
FirstName: JESSICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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Mailing Information
Address1: 8110 MAPLE LAWN BLVD STE 235
Address2:  
City: FULTON
State: MD
PostalCode: 207592694
CountryCode: US
TelephoneNumber: 3013408339
FaxNumber: 3013409027
Practice Location
Address1: 10801 LOCKWOOD DR
Address2: STE 320
City: SILVER SPRING
State: MD
PostalCode: 209011556
CountryCode: US
TelephoneNumber: 3016813400
FaxNumber: 3016817982
Other Information
ProviderEnumerationDate: 11/16/2005
LastUpdateDate: 10/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XD0044405MDN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207VG0400XD0044405MDY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology

No ID Information.


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