Healthcare Provider Details

I. General information

NPI: 1083692693
Provider Name (Legal Business Name): MICHAEL A WEAVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7500
  • Fax: 717-228-1642
Mailing address:
  • Phone: 717-270-7500
  • Fax: 717-228-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD053869L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD053869L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: