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NPI Code Detail

MEDICARE: DR. ERIC J RADCLIFFE MD

MEDICARE:  DR. ERIC J RADCLIFFE  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
1207Q00000XFamily Medicine Physician16836WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3080128624OTHERWVRAILROAD MEDICARE #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12116270OTHERWVALLIANCE
2WV16836AOTHERWVHEALTH PLAN #
4001718907OTHERWVBLUECROSSBLUESHIELD #
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6206377OTHERWVCARELINK/COVENTRY #
78116270OTHERWVMAMSI PROVIDER #

General Provider Information

NPI Number : 1386627743
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC J RADCLIFFE MD
Provider Business Mailing Address
First Line : 527 MEDICAL PARK DR STE 500
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-9010
Country : US
Telephone Number : 681-342-3600
Fax Number : 681-342-3625
Provider Business Practice Location Address
First Line : 527 MEDICAL PARK DR STE 500
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-9010
Country : US
Telephone Number : 681-342-3600
Fax Number : 681-342-3625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 04/06/2022

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Directions to “ DR. ERIC J RADCLIFFE MD” Practice Location

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