Healthcare Provider Details

I. General information

NPI: 1144380502
Provider Name (Legal Business Name): OHIO VALLEY DERMATOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 MARKET ST
WHEELING WV
26003-2912
US

IV. Provider business mailing address

1038 MARKET ST
WHEELING WV
26003-2912
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-7151
  • Fax: 304-232-6128
Mailing address:
  • Phone: 304-232-7151
  • Fax: 304-232-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11124
License Number StateWV

VIII. Authorized Official

Name: ALAN M RUBEN X
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 304-232-7151