Provider Demographics
NPI:1356603146
Name:WEAVER, LAUREN D'ANGELO (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:D'ANGELO
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:D'ANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14960 PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5165
Mailing Address - Country:US
Mailing Address - Phone:281-298-1144
Mailing Address - Fax:281-298-1133
Practice Address - Street 1:920 MEDICAL PLAZA DR STE 120
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3275
Practice Address - Country:US
Practice Address - Phone:281-298-1144
Practice Address - Fax:281-298-1133
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT202213208000000X
TXS36112084E0001X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410428301Medicaid