Healthcare Provider Details

I. General information

NPI: 1942334594
Provider Name (Legal Business Name): OHIO VALLEY RHEUMATOLOGY ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK STE 101
WHEELING WV
26003-6391
US

IV. Provider business mailing address

PO BOX 6158
WHEELING WV
26003-0713
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-1100
  • Fax: 304-242-9810
Mailing address:
  • Phone: 304-233-9314
  • Fax: 304-233-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT L VAWTER
Title or Position: OWNER
Credential: MD
Phone: 304-242-1100