Healthcare Provider Details

I. General information

NPI: 1558207233
Provider Name (Legal Business Name): ROAM WEST VIRGINIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 KANAWHA BLVD E
CHARLESTON WV
25311-2204
US

IV. Provider business mailing address

16352 BRIGADOON TRL
GULF SHORES AL
36542-8249
US

V. Phone/Fax

Practice location:
  • Phone: 719-565-8633
  • Fax:
Mailing address:
  • Phone: 719-565-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DEBORAH ALLEN
Title or Position: ADMINISTRATOR
Credential: PAC
Phone: 719-565-8633