Provider Demographics
NPI:1548477540
Name:WEAVER, MARTIN DOUGLAS SR (MD)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DOUGLAS
Last Name:WEAVER
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:88 OLYMPIA LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4013
Mailing Address - Country:US
Mailing Address - Phone:215-939-3555
Mailing Address - Fax:856-875-7933
Practice Address - Street 1:1200 WALNUT ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5449
Practice Address - Country:US
Practice Address - Phone:215-545-5404
Practice Address - Fax:214-545-5408
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD042968L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation