MEDICARE: DR. RICHARD WEAVER DO

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	42555	CT
2	208VP0014X	Interventional Pain Medicine Physician	042555	CT
3	207L00000X	Anesthesiology Physician	42555	CT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5764115	OTHER	CT	AETNA
3	042555	OTHER	CT	CONNECTICARE
4	223514271	OTHER	CT	UNITED HEALTHCARE
5	223514271	OTHER	CT	HMC/PPO
6	040042555CT01	OTHER	CT	BLUE CROSS BLUE SHIELD
7	2900827006	OTHER	CT	CIGNA

NPI Number	:	1275573651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WEAVER DO

Provider Business Mailing Address
First Line	:	2080 W. ARLINGTON BLVD
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-689-6161
Fax Number	:	252-689-6164

Provider Business Practice Location Address
First Line	:	2080 W ARLINGTON BLVD STE A
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3770
Country	:	US
Telephone Number	:	252-689-6161
Fax Number	:	252-689-6164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/19/2017

2080 W ARLINGTON BLVD , SUITE A
GREENVILLE, NC
27834-3770

Practice Phone: 252-689-6161
Practice Fax: 252-689-6164

2080 W ARLINGTON BLVD STE B
GREENVILLE, NC
27834-3770