Provider Demographics
NPI:1689744252
Name:WEAVER, ELIZABETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:209 ELDEN ST
Mailing Address - Street 2:STE 209
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4852
Mailing Address - Country:US
Mailing Address - Phone:703-466-5000
Mailing Address - Fax:877-795-8153
Practice Address - Street 1:209 ELDEN ST
Practice Address - Street 2:STE 209
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4852
Practice Address - Country:US
Practice Address - Phone:703-466-5000
Practice Address - Fax:877-795-8153
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH70955Medicare UPIN
VA346054OtherANTHEM BC/BS
VAH70955Medicare UPIN
VA5613990Medicaid
VA2177539OtherMAMSI
VA010397H86Medicare ID - Type Unspecified
VA2177539OtherONENET