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General NPI Number Information
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NPI Number | 1568924611
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Entity Type | Individual
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Provider Name | DR. IAN DANIEL THISTLETHWAITE
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Gender | Male
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 501 MORRIS ST
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City | CHARLESTON
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State | WV
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Zip | 25301-1326
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Country | US
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Telephone | 304-388-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 MACCORKLE AVE SE STE B-16
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City | CHARLESTON
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State | WV
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Zip | 25304-1223
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Country | US
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Telephone | 304-388-5848
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 33206
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 33206
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A198420
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 330677
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License Number State | NY
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