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General NPI Number Information
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NPI Number | 1467439463
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Entity Type | Organization
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Legal Business Name | RHEUMATOLOGY AND PULMONARY CLINIC PLLC
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 421 CARRIAGE DR
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City | BECKLEY
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State | WV
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Zip | 25801-2805
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Country | US
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Telephone | 304-256-0242
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Fax | 304-256-0244
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Provider Business Mailing Address
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Address Line | 421 CARRIAGE DR
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City | BECKLEY
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State | WV
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Zip | 25801-2805
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Country | US
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Telephone | 304-256-0242
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Fax | 304-256-0244
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BECKY S FONDALE
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Credential |
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Telephone | 304-256-0242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18402
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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 | 17491
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License Number State | WV
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