Provider Demographics
NPI:1003925991
Name:WESTON, GEORGE W (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:WESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 SAMUEL MORSE DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5317
Mailing Address - Country:US
Mailing Address - Phone:703-893-6168
Mailing Address - Fax:703-790-3444
Practice Address - Street 1:1825 SAMUEL MORSE DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5317
Practice Address - Country:US
Practice Address - Phone:703-893-6168
Practice Address - Fax:703-790-3444
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039622174400000X
VA101039622208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA463704OtherANTHEM NON-PAR PROVIDER #
VA54-1828638OtherTAX ID #
VA54-1828638OtherTAX ID #