MEDICARE: DAVID REVELL 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	207Q00000X	Family Medicine Physician	10966	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00123438	OTHER	WV	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	001709560	OTHER	WV	MT. STATE
3	000000178444	OTHER	WV	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851371058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID REVELL MD

Provider Business Mailing Address
First Line	:	PO BOX 1680
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25717-1680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E MAIN ST
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-1508
Country	:	US
Telephone Number	:	304-743-4444
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	09/16/2013

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Directions to “ DAVID REVELL MD” Practice Location

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