Healthcare Provider Details

I. General information

NPI: 1194721183
Provider Name (Legal Business Name): LORI LYNN ARCHBOLD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK STE 200
WHEELING WV
26003-6391
US

IV. Provider business mailing address

30 MEDICAL PARK STE 200
WHEELING WV
26003-6391
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-8808
  • Fax: 304-243-5113
Mailing address:
  • Phone: 304-243-8808
  • Fax: 304-243-5113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16808
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: