1124002043 NPI number — DR. RICHARD STOCKTON TRENBATH M.D.

Table of content: DR. RICHARD STOCKTON TRENBATH M.D. (NPI 1124002043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124002043 NPI number — DR. RICHARD STOCKTON TRENBATH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRENBATH
Provider First Name:
RICHARD
Provider Middle Name:
STOCKTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1124002043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1049
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24901-4049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-645-4043
Provider Business Mailing Address Fax Number:
304-645-4713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 MERCHANTS WALK
Provider Second Line Business Practice Location Address:
SHOPPING CENTER
Provider Business Practice Location Address City Name:
SUMMERSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26651-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-872-9455
Provider Business Practice Location Address Fax Number:
304-872-9456
Provider Enumeration Date:
12/05/2005

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: 207Q00000X , with the licence number:  12758 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QG0300X , with the licence number: 12758 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3810022256 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002684077 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0053183000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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