Provider Demographics
NPI:1891285490
Name:WEAVER, JANELLE (MD, PHD)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COMMERCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:RAPHINE
Mailing Address - State:VA
Mailing Address - Zip Code:24472-2547
Mailing Address - Country:US
Mailing Address - Phone:540-490-2527
Mailing Address - Fax:540-377-2099
Practice Address - Street 1:25 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:RAPHINE
Practice Address - State:VA
Practice Address - Zip Code:24472-2547
Practice Address - Country:US
Practice Address - Phone:540-490-2527
Practice Address - Fax:540-377-2099
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101277193207Q00000X
WA61110377207Q00000X
WAMD61110377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine