Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D57280 | MD |
Y | 2080A0000X | Adolescent Medicine | D57280 | MD |
NPI | 1255323119 |
---|---|
Provider Name | Leon D Weaver |
First Address | Hagerstown, MD 21740-5574 |
Second Address | Hagerstown, MD 21740-5574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 15/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
982000100 | (05) | MD |