Healthcare Provider Details

I. General information

NPI: 1538124193
Provider Name (Legal Business Name): SHIRLEY M NEITCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 15TH ST SUITE 2000
HUNTINGTON WV
25701-3662
US

IV. Provider business mailing address

1249 15TH ST SUITE 2000
HUNTINGTON WV
25701-3662
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1000
  • Fax: 304-691-1693
Mailing address:
  • Phone: 304-691-1000
  • Fax: 304-691-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12245
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number12245
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: