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NPI Code Detail

MEDICARE: DR. JEFFREY C. DAMERON M.D.

MEDICARE: DR. JEFFREY C. DAMERON 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
12085R0202XDiagnostic Radiology Physician19130WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G87757OTHERWVBRICKSTREET INSURANCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3020011800OTHERWVFEDERAL BLACK LUNG
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5151237200OTHERWVUS DOL & US POSTAL COMP
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7550516458OTHERWVACORDIA NATIONAL PEIA
80130753OTHERWVUMWA
9MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
1055-0516458OTHERWVGROUP FEIN #
11MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12001718806OTHERWVFREEDOM BLUE & MS BCBS
1314193OTHERWVCARELINK & CARELINK PEIA

General Provider Information

NPI Number : 1699779207
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY C. DAMERON M.D.
Provider Business Mailing Address
First Line : PO BOX 11137
Second Line :
City : CHARLESTON
State : WV
Zip : 25339-1137
Country : US
Telephone Number : 304-344-3457
Fax Number : 304-344-3480
Provider Business Practice Location Address
First Line : 1538 KANAWHA BLVD E
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-2435
Country : US
Telephone Number : 304-344-5018
Fax Number : 304-344-3480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 08/12/2024

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