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General NPI Number Information
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NPI Number | 1760789093
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Entity Type | Organization
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Legal Business Name | COGNITIVE MEDICINE PRACTICE PLLC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 310 AMERICAN WAY STE A
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City | WEIRTON
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State | WV
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Zip | 26062-4083
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Country | US
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Telephone | 304-797-6410
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Fax | 740-797-6320
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Provider Business Mailing Address
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Address Line | PO BOX 6230
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City | WHEELING
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State | WV
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Zip | 26003-0722
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Country | US
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Telephone | 304-242-7106
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD O AJAYI
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Credential | MD
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Telephone | 304-797-6410
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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 | 20859
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License Number State | WV
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