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General NPI Number Information
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NPI Number | 1376644625
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Entity Type | Organization
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Legal Business Name | ROBERT J FANNING, JR
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 1307 MOUNT DE CHANTAL RD
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City | WHEELING
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State | WV
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Zip | 26003-6334
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Country | US
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Telephone | 304-242-1273
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Fax | 304-242-1422
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Provider Business Mailing Address
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Address Line | 1307 MOUNT DE CHANTAL RD
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City | WHEELING
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State | WV
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Zip | 26003-6334
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Country | US
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Telephone | 304-242-1273
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Fax | 304-242-1422
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Authorized Official
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Title or Position | CARDIOLOGIST
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Name | DR. ROBERT J FANNING JR.
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Credential | DO
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Telephone | 304-242-1273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 46155
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1431
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License Number State | WV
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