Healthcare Provider Details

I. General information

NPI: 1609876408
Provider Name (Legal Business Name): ROBERT L VAWTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK 101
WHEELING WV
26003-6391
US

IV. Provider business mailing address

30 MEDICAL PARK
WHEELING WV
26003-6391
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-1100
  • Fax: 304-242-9810
Mailing address:
  • Phone: 304-242-1100
  • Fax: 304-242-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number16074
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: