Provider Demographics
NPI:1942395868
Name:WEAVER, TERRY DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DAVID
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SOUTH LINCOLN AVENUE
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-228-5952
Mailing Address - Fax:717-228-5955
Practice Address - Street 1:1700 SOUTH LINCOLN AVENUE
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-228-5952
Practice Address - Fax:717-228-5955
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002516-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery