Healthcare Provider Details

I. General information

NPI: 1720174584
Provider Name (Legal Business Name): RICHARD K UMSTOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WASHINGTON ST E SUITE 208
CHARLESTON WV
25301-1834
US

IV. Provider business mailing address

PO BOX 7000
MORGANTOWN WV
26507-7000
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7270
  • Fax: 304-388-7280
Mailing address:
  • Phone: 304-347-1290
  • Fax: 304-347-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15137
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number15137
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number15137
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberTP130
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberTP130
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTP103
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: