1528010220 NPI number — RICHARD R DURHAM MD

Table of content: RICHARD R DURHAM MD (NPI 1528010220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528010220 NPI number — RICHARD R DURHAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURHAM
Provider First Name:
RICHARD
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528010220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 DUNCAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKEYE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24924-9037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-799-7400
Provider Business Mailing Address Fax Number:
304-799-2276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 DUNCAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKEYE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24924-9037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-799-7400
Provider Business Practice Location Address Fax Number:
304-799-2276
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  0102037025 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 1217 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1528010220 . This is a "HIGHMARK MT STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1528010220 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810005089 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191731 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com