Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01047147 | IN |
NPI | 1114022456 |
---|---|
Provider Name | Carla Weaver |
First Address | Rockville, MD 20850 |
Second Address | Takoma Park, MD 20912-6367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 06/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200385610 | (05) | IN |
H74621 | (02) | |
P01261841 | MEDICARE RR PTAN (01) | IN |