Provider Demographics
NPI:1790804656
Name:ROBERT D. WEAVER DPM INC
Entity Type:Organization
Organization Name:ROBERT D. WEAVER DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-442-3113
Mailing Address - Street 1:6551 WILSON MILLS RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3495
Mailing Address - Country:US
Mailing Address - Phone:440-442-3113
Mailing Address - Fax:440-442-5137
Practice Address - Street 1:6551 WILSON MILLS RD
Practice Address - Street 2:SUITE #104
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3495
Practice Address - Country:US
Practice Address - Phone:440-442-3113
Practice Address - Fax:440-442-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002892213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041407Medicaid
OH9333391Medicare PIN
OHU62299Medicare UPIN
4722440001Medicare NSC