Healthcare Provider Details

I. General information

NPI: 1952596769
Provider Name (Legal Business Name): WAYT HEALTH CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 WHEELING AVE
GLEN DALE WV
26038-1734
US

IV. Provider business mailing address

1612 WHEELING AVE
GLEN DALE WV
26038-1734
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-5700
  • Fax: 304-845-7400
Mailing address:
  • Phone: 304-845-5700
  • Fax: 304-845-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18396
License Number StateWV

VIII. Authorized Official

Name: DR. MICHAEL TIMOTHY WAYT
Title or Position: MEMBER
Credential: M.D.
Phone: 304-845-5700