Healthcare Provider Details

I. General information

NPI: 1609862721
Provider Name (Legal Business Name): COLLEEN J MERIWETHER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 MAIN ST E
WHITE SULPHUR SPRINGS WV
24986-5031
US

IV. Provider business mailing address

1263 MAIN ST E
WHITE SULPHUR SPRINGS WV
24986
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-3665
  • Fax:
Mailing address:
  • Phone: 304-536-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1488
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number1488
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: