Provider Demographics
NPI:1538120191
Name:ALBERT J WEAVER MD
Entity Type:Organization
Organization Name:ALBERT J WEAVER MD
Other - Org Name:HAYMARKET MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-754-4900
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20168-8256
Mailing Address - Country:US
Mailing Address - Phone:703-754-4900
Mailing Address - Fax:571-261-5235
Practice Address - Street 1:14535 JOHN MARSHALL HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4023
Practice Address - Country:US
Practice Address - Phone:703-754-4900
Practice Address - Fax:571-261-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538120191Medicaid
VAC06351Medicare PIN
VAB10024Medicare UPIN