Provider Demographics
NPI:1215039649
Name:WEAVER, ARLONDRA (PA)
Entity type:Individual
Prefix:
First Name:ARLONDRA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BLANDING ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3441
Mailing Address - Country:US
Mailing Address - Phone:803-999-5920
Mailing Address - Fax:803-999-5930
Practice Address - Street 1:1715 BLANDING ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3441
Practice Address - Country:US
Practice Address - Phone:803-999-5920
Practice Address - Fax:803-999-5930
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104092363AM0700X
SC1002363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ36134Medicare UPIN