Healthcare Provider Details

I. General information

NPI: 1669403226
Provider Name (Legal Business Name): ESTON ROBERT CALDWELL III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/12/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17978 SR 55
BAKER WV
26801-2680
US

IV. Provider business mailing address

PO BOX 97
BAKER WV
26801-0097
US

V. Phone/Fax

Practice location:
  • Phone: 304-897-5915
  • Fax:
Mailing address:
  • Phone: 304-897-5915
  • Fax: 304-897-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101035637
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29784
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: