Active NPI
Mark D Wiederhold, M.D.
- Internal Medicine Physician
- San Diego, CA
National Provider Identifier
1598015745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- G66151
- Practice address
- 9565 Waples St
Suite 200
San Diego, CA 92121-2986 - Phone
- (858) 642-0267
- Fax
- (858) 642-0285
- NPI assigned
- Sep 14, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G66151 | CA | Primary |
Addresses
Primary practice location
9565 Waples St
Suite 200
San Diego, CA 92121-2986
Mailing address
9565 Waples St
Suite 200
San Diego, CA 92121-2986
Phone (858) 642-0267
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66151 | CA | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347580800000",
"number": "1598015745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9565 WAPLES ST",
"address_2": "SUITE 200",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921212986",
"telephone_number": "858-642-0267",
"fax_number": "858-642-0285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9565 WAPLES ST",
"address_2": "SUITE 200",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921212986",
"telephone_number": "858-642-0267",
"fax_number": "858-642-0285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDERHOLD",
"first_name": "MARK",
"middle_name": "D",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-14",
"last_updated": "2012-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G66151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.