Provider Demographics
NPI:1013908748
Name:WEEDEN, GERARD J (DO)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:J
Last Name:WEEDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7101 JAHNKE RD
Mailing Address - Street 2:SUITE 611
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4017
Mailing Address - Country:US
Mailing Address - Phone:804-327-4046
Mailing Address - Fax:804-327-4047
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 611
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-327-4046
Practice Address - Fax:804-327-4047
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102201286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010054010Medicaid
VA1013908748Medicaid
P00193823OtherRR MEDICARE
VA010054010Medicaid
P00193823OtherRR MEDICARE