Healthcare Provider Details

I. General information

NPI: 1477880029
Provider Name (Legal Business Name): ANITHA WEAVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANITHA MARY JAMES MD

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGHLANDS DR SUITE 204
LITITZ PA
17543-7693
US

IV. Provider business mailing address

100 HIGHLANDS DR SUITE 204
LITITZ PA
17543-7693
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-5437
  • Fax: 717-626-0875
Mailing address:
  • Phone: 717-626-5437
  • Fax: 717-626-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD441955
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MD08583500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: