Individual
DR. MICAELA WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1 BLACKSTONE STREET, 2ND FLOOR, PROVIDENCE, RI 02903
(401) 453-7520
Mailing address
1 BLACKSTONE PL, PROVIDENCE, RI 02903-4942
(401) 453-7540
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
DO00965
RI
2086X0206X
Surgical Oncology Physician
285738
MA
2086X0206X
Surgical Oncology Physician
Primary
DO00965
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
07/11/2014
Last updated
06/25/2021
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