Provider Demographics
NPI:1790741130
Name:WEAVER, HOWARD A (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-7111
Mailing Address - Fax:802-786-1405
Practice Address - Street 1:1 ALBERT CREE DR
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-786-1400
Practice Address - Fax:802-786-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0004441207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004728Medicaid
VT04728OtherBCBS
1752688OtherCIGNA
10138OtherMVP
C65267Medicare UPIN
VT0004728Medicaid
VT04728OtherBCBS