MEDICARE: STEPHEN KARL RERYCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	22335	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134174212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN KARL RERYCH MD

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	PT PLEASANT
State	:	WV
Zip	:	25550-0236
Country	:	US
Telephone Number	:	304-675-1666
Fax Number	:	304-675-5893

Provider Business Practice Location Address
First Line	:	2520 VALLEY DR
Second Line	:
City	:	PT PLEASANT
State	:	WV
Zip	:	25550-2031
Country	:	US
Telephone Number	:	304-675-1666
Fax Number	:	304-675-2944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	01/27/2010

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