Healthcare Provider Details

I. General information

NPI: 1336104132
Provider Name (Legal Business Name): LAUREL DE PADUA WEAVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11848 ROCK LANDING DR
NEWPORT NEWS VA
23606-4425
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 757-591-2260
  • Fax:
Mailing address:
  • Phone: 800-394-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101038717
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: