Healthcare Provider Details

I. General information

NPI: 1770526139
Provider Name (Legal Business Name): PETE JOSEPH PALKO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/16/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MCCLELLAN RD
PHILIPPI WV
26416-8076
US

IV. Provider business mailing address

116 MCCLELLAN RD
PHILIPPI WV
26416-8076
US

V. Phone/Fax

Practice location:
  • Phone: 304-457-2800
  • Fax: 304-457-4011
Mailing address:
  • Phone: 304-457-2800
  • Fax: 304-457-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2053
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: