Healthcare Provider Details

I. General information

NPI: 1376542290
Provider Name (Legal Business Name): DAVID RALPH FERRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GRAND CENTRAL AVE STE 115
VIENNA WV
26105-1079
US

IV. Provider business mailing address

1500 GRAND CENTRAL AVE STE 115
VIENNA WV
26105-1079
US

V. Phone/Fax

Practice location:
  • Phone: 304-295-2311
  • Fax:
Mailing address:
  • Phone: 304-295-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19776
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19776
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35076392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: