Healthcare Provider Details

I. General information

NPI: 1639960099
Provider Name (Legal Business Name): DAVID DERFLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 KILSYTH RD
MOUNT HOPE WV
25880-1561
US

IV. Provider business mailing address

135 LITTLE VINE DR
BEAVER WV
25813-9698
US

V. Phone/Fax

Practice location:
  • Phone: 304-719-1938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: