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NPI Code Detail

MEDICARE: NOEL M. DOROMAL M.D.

MEDICARE: NOEL M. DOROMAL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist21802WV

General Provider Information

NPI Number : 1568459162
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOEL M. DOROMAL M.D.
Provider Business Mailing Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number : 304-766-3600
Fax Number : 304-766-3477
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number : 304-766-3600
Fax Number : 304-766-3477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 07/17/2009

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