Healthcare Provider Details

I. General information

NPI: 1508969429
Provider Name (Legal Business Name): ANDREW ALAN TALKINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MED CENTER DR LOUIS A JOHNSON VA MEDICAL CENTER
CLARKSBURG WV
26301-4155
US

IV. Provider business mailing address

1 MED CENTER DR LOUIS A JOHNSON VA MEDICAL CENTER
CLARKSBURG WV
26301-4155
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax:
Mailing address:
  • Phone: 304-622-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17497
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: