Healthcare Provider Details

I. General information

NPI: 1730150251
Provider Name (Legal Business Name): JOHN PATRICK FERNALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 COMMERCE DR
BEAVER WV
25813-8985
US

IV. Provider business mailing address

1619 STANAFORD RD STE 208
BECKLEY WV
25801-8624
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-0150
  • Fax: 304-250-0153
Mailing address:
  • Phone: 304-929-6930
  • Fax: 304-929-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23655
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234192
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: