Healthcare Provider Details

I. General information

NPI: 1063514776
Provider Name (Legal Business Name): RAYMOND K DIPINO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MORRIS ST
CHARLESTON WV
25301-1326
US

IV. Provider business mailing address

PO BOX 7000
MORGANTOWN WV
26507-7000
US

V. Phone/Fax

Practice location:
  • Phone: 304-341-1500
  • Fax: 304-341-1570
Mailing address:
  • Phone: 304-347-1290
  • Fax: 304-347-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number801
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: