Healthcare Provider Details

I. General information

NPI: 1891896809
Provider Name (Legal Business Name): LAUREL ANN WEAVER MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/05/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE CHILDREN'S HOSPITAL OF PHILADELPHIA 3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

4601 MARKET ST STE 300
PHILADELPHIA PA
19139-4636
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7555
  • Fax:
Mailing address:
  • Phone: 215-590-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD427523
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD427523
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: