1699711044 NPI number — CRAIG E WEAVER MSPT

Table of content: CRAIG E WEAVER MSPT (NPI 1699711044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699711044 NPI number — CRAIG E WEAVER MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEAVER
Provider First Name:
CRAIG
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699711044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 TWIN C LN
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-2157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-633-1280
Provider Business Mailing Address Fax Number:
302-633-1284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 TWIN C LN
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-633-1280
Provider Business Practice Location Address Fax Number:
302-633-1284
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  J10001409 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT008320L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1744466581 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61926301 . This is a "NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5070-0019 . This is a "CARE FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: J10001409 . This is a "DE LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0452012000 . This is a "AMERIHEALTH/IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 880770 . This is a "PABS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0452012000 . This is a "AMERIHEALTH IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000037865 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880770 . This is a "CAREFIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 428833 . This is a "PA BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PT008320L . This is a "PA LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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