Provider Demographics
NPI:1609984582
Name:WEAVER, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:WEAVER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1041 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6156
Mailing Address - Country:US
Mailing Address - Phone:843-881-0007
Mailing Address - Fax:843-884-3690
Practice Address - Street 1:1041 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6156
Practice Address - Country:US
Practice Address - Phone:843-881-0007
Practice Address - Fax:843-884-3690
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-05-09
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Provider Licenses
StateLicense IDTaxonomies
SCSC14882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCOTH000Medicare UPIN