Provider Demographics
NPI:1083612345
Name:WEAVER, ANNE C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:C
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COTTAGE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2172
Mailing Address - Country:US
Mailing Address - Phone:413-549-8888
Mailing Address - Fax:413-549-8886
Practice Address - Street 1:29 COTTAGE ST
Practice Address - Street 2:SUITE C
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2172
Practice Address - Country:US
Practice Address - Phone:413-549-8888
Practice Address - Fax:413-549-8886
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213299207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0195090Medicaid
MD692597OtherHARVARD PILGRIM
MA213299OtherCONNECTICARE
MD213299OtherTUFTS
MDJ24836OtherBLUE CROSS
MA30189OtherHEALTH NEW ENGLAND
MD2864065OtherAETNA
MA213299OtherCONNECTICARE