Provider Demographics
NPI:1275573651
Name:WEAVER, RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 W. ARLINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-689-6161
Mailing Address - Fax:252-689-6164
Practice Address - Street 1:2080 W ARLINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3770
Practice Address - Country:US
Practice Address - Phone:252-689-6161
Practice Address - Fax:252-689-6164
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42555208VP0014X, 207L00000X
CT042555208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001425554Medicaid
CT5764115OtherAETNA
CT042555OtherCONNECTICARE
CT223514271OtherUNITED HEALTHCARE
CT223514271OtherHMC/PPO
CT040042555CT01OtherBLUE CROSS BLUE SHIELD
CT2900827006OtherCIGNA
CT050001439Medicare ID - Type Unspecified
CT040042555CT01OtherBLUE CROSS BLUE SHIELD