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General NPI Number Information
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NPI Number | 1952736357
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Entity Type | Organization
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Legal Business Name | WHEELING FOOT CLINIC
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 903 WHEELING AVE
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City | GLEN DALE
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State | WV
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Zip | 26038-1662
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Country | US
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Telephone | 304-843-5066
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Fax | 304-843-5067
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Provider Business Mailing Address
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Address Line | 903 WHEELING AVE
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City | GLEN DALE
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State | WV
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Zip | 26038-1662
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Country | US
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Telephone | 304-843-5066
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Fax | 304-843-5067
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | DAVID J ROMANO
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Credential | DPM
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Telephone | 304-843-5066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 10417
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License Number State | WV
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