Healthcare Provider Details

I. General information

NPI: 1386600153
Provider Name (Legal Business Name): LUNDA E. WEAVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OAKDALE RD
MARTINSBURG PA
16662-1246
US

IV. Provider business mailing address

PO BOX 247
MARTINSBURG PA
16662-0247
US

V. Phone/Fax

Practice location:
  • Phone: 814-793-3388
  • Fax: 814-793-3388
Mailing address:
  • Phone: 814-793-3388
  • Fax: 814-793-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD027309E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: