Provider Demographics
NPI:1679018899
Name:WEAKLEY, ZACHARY
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:WEAKLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 PIMMIT DR
Mailing Address - Street 2:APT 316
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2811
Mailing Address - Country:US
Mailing Address - Phone:540-598-2788
Mailing Address - Fax:
Practice Address - Street 1:20410 CENTURY BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1186
Practice Address - Country:US
Practice Address - Phone:301-986-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program