Healthcare Provider Details

I. General information

NPI: 1528279643
Provider Name (Legal Business Name): LUNDA E. WEAVER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OAKDALE RD
MARTINSBURG PA
16662-1246
US

IV. Provider business mailing address

300 OAKDALE RD
MARTINSBURG PA
16662-1246
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 027309E
License Number StatePA

VIII. Authorized Official

Name: DR. LUNDA E. WEAVER
Title or Position: OWNER
Credential: M.D.
Phone: 814-793-3388