Healthcare Provider Details

I. General information

NPI: 1922011063
Provider Name (Legal Business Name): RANDALL P WEYRICH MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 8TH ST SUITE 202
GLEN DALE WV
26038-1451
US

IV. Provider business mailing address

426 8TH ST SUITE 202
GLEN DALE WV
26038-1451
US

V. Phone/Fax

Practice location:
  • Phone: 304-843-1433
  • Fax: 304-843-6956
Mailing address:
  • Phone: 304-843-1433
  • Fax: 304-843-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number009633
License Number StateWV

VIII. Authorized Official

Name: RANDALL P WEYRICH
Title or Position: PRESIDENT
Credential: MD
Phone: 304-843-1433