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General NPI Number Information
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NPI Number | 1114003084
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Entity Type | Organization
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Legal Business Name | PSYCHCONSULTMD
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 206 SKYLAR DR
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City | LEWISBURG
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State | WV
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Zip | 24901
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Country | US
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Telephone | 336-978-4618
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Fax |
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Provider Business Mailing Address
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Address Line | 206 SKYLAR DR
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City | LEWISBURG
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State | WV
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Zip | 24901
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Country | US
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Telephone | 336-978-4618
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DOUGLAS RAY EITEL
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Credential | MD
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Telephone | 336-978-4618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21057
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License Number State | WV
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