Provider Demographics
NPI:1932172533
Name:WEAVER, CYNTHIA ANDERSON
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANDERSON
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:STE. 203
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-249-6960
Mailing Address - Fax:218-249-6969
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:STE. 203
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-249-6960
Practice Address - Fax:218-249-6969
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2745207RR0500X
MN54010207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S41216Medicare PIN