Healthcare Provider Details

I. General information

NPI: 1851371058
Provider Name (Legal Business Name): DAVID REVELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E MAIN ST
MILTON WV
25541-1508
US

IV. Provider business mailing address

PO BOX 1680
HUNTINGTON WV
25717-1680
US

V. Phone/Fax

Practice location:
  • Phone: 304-743-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10966
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: