Healthcare Provider Details

I. General information

NPI: 1376764985
Provider Name (Legal Business Name): MEDICAL PARK ANESTHESIOLOGISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK
WHEELING WV
26003-6379
US

IV. Provider business mailing address

PO BOX 6732
WHEELING WV
26003-0656
US

V. Phone/Fax

Practice location:
  • Phone: 304-233-2455
  • Fax: 304-233-6073
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN E DUDICH
Title or Position: PRESIDENT
Credential: MD
Phone: 304-233-2455