Provider Demographics
NPI:1336511971
Name:ELIZABETH M WEAVER, M.D., P.L.C.
Entity Type:Organization
Organization Name:ELIZABETH M WEAVER, M.D., P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-466-5150
Mailing Address - Street 1:1031 STERLING RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3865
Mailing Address - Country:US
Mailing Address - Phone:703-466-5150
Mailing Address - Fax:703-649-3557
Practice Address - Street 1:1031 STERLING RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3865
Practice Address - Country:US
Practice Address - Phone:703-466-5150
Practice Address - Fax:703-649-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty