Healthcare Provider Details

I. General information

NPI: 1043278450
Provider Name (Legal Business Name): RICHARD A. COULON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR. SUITE G-500
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR SUITE G-500
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1787
  • Fax: 304-691-8711
Mailing address:
  • Phone: 303-691-1787
  • Fax: 304-691-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD.010050
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number23103
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: