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General NPI Number Information
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NPI Number | 1124010459
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Entity Type | Individual
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Provider Name | JERRY I HADRYCH DPM
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 603 ALTA VISTA AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-4185
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Country | US
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Telephone | 304-333-3338
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Fax | 304-333-3201
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Provider Business Mailing Address
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Address Line | 603 ALTA VISTA AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-4185
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Country | US
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Telephone | 304-333-3338
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Fax | 304-333-3201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 320
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License Number State | WV
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