Healthcare Provider Details

I. General information

NPI: 1245499425
Provider Name (Legal Business Name): AMY ROBIN DEIPOLYI M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE FL 4
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5590
  • Fax:
Mailing address:
  • Phone: 304-388-8199
  • Fax: 304-388-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number243425
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number30543
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number243425
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: