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NPI Code Detail

MEDICARE: DR. EDUARDO MIGUEL VIDAL M.D.

MEDICARE: DR. EDUARDO MIGUEL VIDAL M.D.
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
1207ND0101XMOHS-Micrographic Surgery PhysicianME83671FL
2207ND0101XMOHS-Micrographic Surgery Physician30229WV

Other Identifiers

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

General Provider Information

NPI Number : 1356327951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDUARDO MIGUEL VIDAL M.D.
Provider Business Mailing Address
First Line : 1400 HAL GREER BLVD FL 2
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-4114
Country : US
Telephone Number : 304-691-1930
Fax Number :
Provider Business Practice Location Address
First Line : 1400 HAL GREER BLVD FL 2
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-4114
Country : US
Telephone Number : 304-691-1930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 11/23/2021

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