Provider Demographics
NPI:1356318604
Name:WEAVER, STEVEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6046 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7616
Mailing Address - Country:US
Mailing Address - Phone:330-433-1771
Mailing Address - Fax:330-493-9046
Practice Address - Street 1:4065 BRADLEY CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2565
Practice Address - Country:US
Practice Address - Phone:330-433-1770
Practice Address - Fax:330-493-9046
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35062374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0934065Medicaid
OH0934065Medicaid
OHF53709Medicare UPIN