Healthcare Provider Details

I. General information

NPI: 1578509311
Provider Name (Legal Business Name): MICHAEL S SUMMERFIELD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GARFIELD AVE
PARKERSBURG WV
26101-5340
US

IV. Provider business mailing address

PO BOX 759008
BALTIMORE MD
21275-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-422-1666
  • Fax: 904-346-0113
Mailing address:
  • Phone: 304-422-1666
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberI09214
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34-00-7861-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: