Provider Demographics
NPI:1053632083
Name:WEAVER, BRANDON SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 HAWKINS POINT RD
Mailing Address - Street 2:BUILDING 28A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21226-1797
Mailing Address - Country:US
Mailing Address - Phone:410-636-7506
Mailing Address - Fax:410-636-7868
Practice Address - Street 1:2401 HAWKINS POINT RD
Practice Address - Street 2:BUILDING 28A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21226-1797
Practice Address - Country:US
Practice Address - Phone:410-636-7506
Practice Address - Fax:410-636-7868
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60263373363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical