1245230549 NPI number — WILLIAM L NOBLE MD

Table of content: WILLIAM L NOBLE MD (NPI 1245230549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245230549 NPI number — WILLIAM L NOBLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOBLE
Provider First Name:
WILLIAM
Provider Middle Name:
L
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:
1245230549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26507-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-598-2291
Provider Business Mailing Address Fax Number:
304-598-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 J D ANDERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-598-2291
Provider Business Practice Location Address Fax Number:
304-598-2293
Provider Enumeration Date:
07/28/2005

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: 2085R0202X , with the licence number:  11182 , 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: 11052488 . This is a "CAQH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0176367 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007720620006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00359305 . This is a "RRMC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0007720620002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007720620003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1036220 . This is a "WORKERS COMP PIN NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0123006000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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