Healthcare Provider Details

I. General information

NPI: 1043715667
Provider Name (Legal Business Name): ANDREW DERRON VESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 STAUNTON AVE SE FL 1
CHARLESTON WV
25304-1477
US

IV. Provider business mailing address

3508 STAUNTON AVE SE FL 1
CHARLESTON WV
25304-1477
US

V. Phone/Fax

Practice location:
  • Phone: 304-356-3637
  • Fax:
Mailing address:
  • Phone: 304-356-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number30949
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: