MEDICARE: DR. DANIEL C WEAVER M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD046339L	PA
2	207Q00000X	Family Medicine Physician	277059-1	NY

General Provider Information

NPI Number	:	1548391915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL C WEAVER M.D.

Provider Business Mailing Address
First Line	:	584 COUNTY HIGHWAY 22
Second Line	:
City	:	BURLINGTON FLATS
State	:	NY
Zip	:	13315-3520
Country	:	US
Telephone Number	:	315-418-6425
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 TURNER LANE
Second Line	:
City	:	EDMESTON
State	:	NY
Zip	:	13335
Country	:	US
Telephone Number	:	607-965-8900
Fax Number	:	607-965-8631

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	02/15/2016

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