Provider Demographics
NPI:1053334094
Name:WEAVER, YVONNE JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:JACKSON
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8001 FRANKLIN FARMS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5108
Mailing Address - Country:US
Mailing Address - Phone:804-521-5800
Mailing Address - Fax:804-545-4340
Practice Address - Street 1:7401 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5520
Practice Address - Country:US
Practice Address - Phone:804-323-5011
Practice Address - Fax:804-323-5120
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101025448207UN0901X
VA0101030305207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA27413300OtherFEDERAL BLACK LUNG
VA4063733OtherAETNA/US HEALTHCARE
VA2689960OtherCIGNA
VA10063159Medicaid
VA60042101OtherRAILROAD MEDICARE
VA5804868Medicaid
VA69563OtherSOUTHERN HEALTH SERVICES
VA276368OtherANTHEM/VA HEALTHKEEPERS
VA113019OtherANTHEM/VA HEALTHKEEPERS
VA276283OtherANTHEM/VA HEALTHKEEPERS
VA411515OtherMAMSI
VA113000OtherANTHEM/VA HEALTHKEEPERS
VA113018OtherANTHEM/VA HEALTHKEEPERS
VA276212OtherANTHEM/VA HEALTHKEEPERS
VA533768OtherAETNA/US HEALTHCARE HMO
VA103806OtherANTHEM/VA HEALTHKEEPERS
VA44233OtherSENTARA HEALTH/OPTIMA
VA27413300OtherFEDERAL BLACK LUNG
VA411515OtherMAMSI