Provider Demographics
NPI:1558406645
Name:WEAVER, ROBERT A III (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:WEAVER
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2400
Mailing Address - Country:US
Mailing Address - Phone:508-358-1112
Mailing Address - Fax:508-358-3441
Practice Address - Street 1:30 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2400
Practice Address - Country:US
Practice Address - Phone:508-358-1112
Practice Address - Fax:508-358-3441
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3083103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03264OtherBLUE CROSS BLUE SHIELD