Healthcare Provider Details

I. General information

NPI: 1366407843
Provider Name (Legal Business Name): CALVIN J. MORSE R.D., L.D., L.D.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VETERANS AVE
BECKLEY WV
25801-6444
US

IV. Provider business mailing address

200 VETERANS AVE
BECKLEY WV
25801-6444
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-2121
  • Fax:
Mailing address:
  • Phone: 304-255-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: