Provider Demographics
NPI:1336163658
Name:WEAVER, ROBERT GREGORY I (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GREGORY
Last Name:WEAVER
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21975
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4116
Mailing Address - Country:US
Mailing Address - Phone:540-321-4281
Mailing Address - Fax:540-321-4282
Practice Address - Street 1:541 SUNSET LN STE 301
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701
Practice Address - Country:US
Practice Address - Phone:540-825-4557
Practice Address - Fax:540-852-4566
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056829207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336163658Medicaid
VA1336163658Medicaid
VAP00822133OtherMEDICARE RAILROAD
VA022214P75Medicare PIN