Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 76585 | MA |
NPI | 1053312843 |
---|---|
Provider Name | Rebecca M Weaver |
First Address | Framingham, MA 01702-8264 |
Second Address | Framingham, MA 01702-8264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 27/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3153568 | (05) | MA |
G25455 | (02) | MA |