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General NPI Number Information
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NPI Number | 1659585263
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Entity Type | Organization
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Legal Business Name | WHITEHALL MEDICAL PLLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 60 ROXBURY ROAD
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City | WHITE HALL
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State | WV
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Zip | 26554-3430
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Country | US
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Telephone | 304-363-6600
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Fax | 304-363-7700
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Provider Business Mailing Address
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Address Line | 60 ROXBURY ROAD
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City | WHITE HALL
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State | WV
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Zip | 26554-3430
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Country | US
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Telephone | 304-363-6600
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Fax | 304-363-7700
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Authorized Official
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Title or Position | MEMBER SINGLE OWNER
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Name | DR. RICHARD E VASICEK
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Credential |
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Telephone | 304-363-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5100942930
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License Number State | WV
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