Healthcare Provider Details

I. General information

NPI: 1386639243
Provider Name (Legal Business Name): LARRY DOUGLAS CURNUTTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 MACCORKLE AVE SW SUITE 200
SOUTH CHARLESTON WV
25309-1444
US

IV. Provider business mailing address

4501 MACCORKLE AVE SW SUITE 200
SOUTH CHARLESTON WV
25309-1444
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-9600
  • Fax: 304-766-9606
Mailing address:
  • Phone: 304-766-9600
  • Fax: 304-766-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8869
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: