Individual
GLENN E WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
575 N RIVER ST, WILKES BARRE, PA 18764-0999
(570) 829-8111
Mailing address
3998 FAIR RIDGE DR, SUITE 300, FAIRFAX, VA 22033-2921
(703) 259-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OS0006308L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014412060007
—
PA
01
—
P01055356
RAILROAD MEDICARE
PA
Enumeration date
05/12/2006
Last updated
04/21/2015
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