Healthcare Provider Details

I. General information

NPI: 1275573651
Provider Name (Legal Business Name): RICHARD WEAVER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W ARLINGTON BLVD STE A
GREENVILLE NC
27834-3770
US

IV. Provider business mailing address

2080 W. ARLINGTON BLVD SUITE A
GREENVILLE NC
27834
US

V. Phone/Fax

Practice location:
  • Phone: 252-689-6161
  • Fax: 252-689-6164
Mailing address:
  • Phone: 252-689-6161
  • Fax: 252-689-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number42555
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number042555
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number42555
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: