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General NPI Number Information
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NPI Number | 1598786592
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Entity Type | Organization
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Legal Business Name | ROLAND F CHALIFOUX JR DO PLLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 1001 W BALTIMORE ST
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City | MCMECHEN
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State | WV
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Zip | 26040-1503
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Country | US
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Telephone | 304-242-4004
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Fax | 304-242-8004
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Provider Business Mailing Address
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Address Line | 1001 W BALTIMORE ST
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City | MCMECHEN
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State | WV
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Zip | 26040-1503
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Country | US
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Telephone | 304-242-4004
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Fax | 304-242-8004
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Authorized Official
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Title or Position | OWNER
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Name | ROLAND F CHALIFOUX JR
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Credential | DO
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Telephone | 304-242-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 2077
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License Number State | WV
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