Healthcare Provider Details

I. General information

NPI: 1295737153
Provider Name (Legal Business Name): ANN M. LAMBERNEDIS M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ANN M. AKINS

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GREAT TEAYS BLVD STE 101
SCOTT DEPOT WV
25560-9548
US

IV. Provider business mailing address

2585 3RD AVE
HUNTINGTON WV
25703-1642
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-8803
  • Fax: 304-757-8803
Mailing address:
  • Phone: 304-697-1396
  • Fax: 304-697-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number18165
License Number StateWV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0110154000
Identifier TypeMEDICAID
Identifier StateWV
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: