Provider Demographics
NPI:1700072790
Name:WEAVER, TIMOTHY VINCENT (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:VINCENT
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 1:16 MANOR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-1132
Mailing Address - Country:US
Mailing Address - Phone:717-872-5444
Mailing Address - Fax:717-872-1537
Practice Address - Street 1:16 MANOR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1130
Practice Address - Country:US
Practice Address - Phone:717-872-5444
Practice Address - Fax:717-872-1537
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42455174400000X, 207Q00000X
PAMD431573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist