Provider Demographics
NPI:1154419802
Name:DOCTORS WEAVER & WEAVER P C
Entity type:Organization
Organization Name:DOCTORS WEAVER & WEAVER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEBESTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-772-7107
Mailing Address - Street 1:5304 INDIAN GRAVE RD SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-9108
Mailing Address - Country:US
Mailing Address - Phone:540-772-7107
Mailing Address - Fax:540-772-7858
Practice Address - Street 1:5304 INDIAN GRAVE RD SW
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-9108
Practice Address - Country:US
Practice Address - Phone:540-772-7107
Practice Address - Fax:540-772-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033189207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006196705Medicaid
C12923OtherRAILROAD MEDICARE LEGACY
VA006104321Medicaid
G48487Medicare UPIN
VA006104321Medicaid
B07189Medicare UPIN
VAC01334Medicare PIN