Provider Demographics
NPI:1447244009
Name:WEAVER, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:555 HERNDON PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5276
Mailing Address - Country:US
Mailing Address - Phone:703-481-1505
Mailing Address - Fax:703-742-8793
Practice Address - Street 1:555 HERNDON PKWY
Practice Address - Street 2:STE 100
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5276
Practice Address - Country:US
Practice Address - Phone:703-481-1505
Practice Address - Fax:703-742-8793
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101037692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0562243Medicaid
VA080182910OtherRR MEDICARE
VA00A429E32Medicare ID - Type Unspecified
C62783Medicare UPIN