Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 101039622 | VA |
Y | 208600000X | Surgeon | 101039622 | VA |
NPI | 1003925991 |
---|---|
Provider Name | Dr. George W. Weston |
First Address | Reston, VA 20190-5317 |
Second Address | Reston, VA 20190-5317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 13/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
463704 | ANTHEM NON-PAR PROVIDER # (01) | VA |
54-1828638 | TAX ID # (01) | VA |
C61944 | (02) | VA |