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General NPI Number Information
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NPI Number | 1881762276
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Entity Type | Organization
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Legal Business Name | HUNTINGTON BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 5960 ROUTE 60 EAST SUITE 2
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City | BARBOURSVILLE
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State | WV
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Zip | 25504
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Country | US
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Telephone | 304-757-5877
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Fax | 304-757-5878
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Provider Business Mailing Address
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Address Line | PO BOX 907
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City | BARBOURSVILLE
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State | WV
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Zip | 25504
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Country | US
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Telephone | 304-757-5877
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Fax | 304-757-5878
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTONIO R DIAZ JR.
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Credential | M.D.
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Telephone | 304-757-5877
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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 | 16814
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License Number State | WV
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