Individual
KELLY WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7137 MT PLEASANT RD, CANASTOTA, NY 13032-5024
(315) 697-2033
(315) 697-9175
Mailing address
7137 MT PLEASANT RD, CANASTOTA, NY 13032-5024
(315) 697-2033
(315) 697-9175
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
250839
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03178347
—
NY
Enumeration date
12/01/2008
Last updated
09/16/2021
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