Provider Demographics
NPI:1396855615
Name:WEAVER, VIRGINIA MCGRATH (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MCGRATH
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:P O BOX 1000 DEPT 457
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-275-3662
Mailing Address - Fax:901-271-0155
Practice Address - Street 1:57 GERMANTOWN CT STE 204
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-266-6445
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37435208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00010284OtherRAILROAD MEDICARE
TN3880911Medicaid
TN3880911Medicaid
TN3880911Medicare ID - Type Unspecified