1447440060 NPI number — MRS. ELLEN ADELIA DOEBLER PA-C, LRD, CDE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447440060 NPI number — MRS. ELLEN ADELIA DOEBLER PA-C, LRD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOEBLER
Provider First Name:
ELLEN
Provider Middle Name:
ADELIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C, LRD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAISER
Provider Other First Name:
ELLEN
Provider Other Middle Name:
ADELIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447440060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 CAMPUS BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-5100
Provider Business Mailing Address Fax Number:
540-536-0235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4803 GERRARDSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INWOOD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25428-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-821-9011
Provider Business Practice Location Address Fax Number:
304-821-9012
Provider Enumeration Date:
07/30/2007

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: 363A00000X , with the licence number:  0110006335 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 2064 , 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)





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