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General NPI Number Information
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NPI Number | 1215339098
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Entity Type | Organization
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Legal Business Name | RAINBOW PEDIATRICS, INC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 354 COMMERCE DR
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City | BEAVER
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State | WV
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Zip | 25813-8985
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Country | US
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Telephone | 304-250-0150
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Fax | 304-250-0153
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Provider Business Mailing Address
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Address Line | 1619 STANAFORD RD STE 208
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City | BECKLEY
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State | WV
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Zip | 25801-8624
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Country | US
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Telephone | 304-250-0150
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Fax | 304-250-0153
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN P. FERNALD
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Credential | M.D.
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Telephone | 304-250-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 23655
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License Number State | WV
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