Provider Demographics
NPI:1801899273
Name:WEAVER, MICHAEL D (MD, FACR)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2801
Mailing Address - Country:US
Mailing Address - Phone:252-752-5000
Mailing Address - Fax:252-752-0166
Practice Address - Street 1:9 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2801
Practice Address - Country:US
Practice Address - Phone:252-752-5000
Practice Address - Fax:252-752-0166
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-183492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986186Medicaid
NC86186OtherBLUE CROSS BLUE SHIELD NC
NC213394AMedicare ID - Type Unspecified
NC8986186Medicaid
NC86186OtherBLUE CROSS BLUE SHIELD NC