Healthcare Provider Details

I. General information

NPI: 1104022680
Provider Name (Legal Business Name): TONJA I WEED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONJA PALAURO MD

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD SALEM VAMC (112)
SALEM VA
24153-6404
US

IV. Provider business mailing address

1970 ROANOKE BLVD SALEM VAMC (112)
SALEM VA
24153-6404
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-983-1090
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-983-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101238345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: