Healthcare Provider Details

I. General information

NPI: 1144363912
Provider Name (Legal Business Name): RYAN WEAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MUNRO AVE
CAPE MAY NJ
08204-5000
US

IV. Provider business mailing address

1281 WILSON DR
CAPE MAY NJ
08204-5269
US

V. Phone/Fax

Practice location:
  • Phone: 410-937-1462
  • Fax:
Mailing address:
  • Phone: 609-898-6610
  • Fax: 609-898-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberVAD000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: