MEDICARE: DR. JOHN PATRICK FERNALD 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	208000000X	Pediatrics Physician	23655	WV
2	208000000X	Pediatrics Physician	0101234192	VA

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

General Provider Information

NPI Number	:	1730150251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK FERNALD MD

Provider Business Mailing Address
First Line	:	1619 STANAFORD RD STE 208
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-8624
Country	:	US
Telephone Number	:	304-929-6930
Fax Number	:	304-929-6935

Provider Business Practice Location Address
First Line	:	354 COMMERCE DR
Second Line	:
City	:	BEAVER
State	:	WV
Zip	:	25813-8985
Country	:	US
Telephone Number	:	304-250-0150
Fax Number	:	304-250-0153

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	10/09/2025

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