Healthcare Provider Details

I. General information

NPI: 1891285490
Provider Name (Legal Business Name): JANELLE WEAVER MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 07/24/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COMMERCE PARK DR
RAPHINE VA
24472-2547
US

IV. Provider business mailing address

25 COMMERCE PARK DR
RAPHINE VA
24472-2547
US

V. Phone/Fax

Practice location:
  • Phone: 540-490-2527
  • Fax: 540-377-2099
Mailing address:
  • Phone: 540-490-2527
  • Fax: 540-377-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61110377
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61110377
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101277193
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: