1306821772 NPI number — DR. ROBERT A CAVENEY MD

Table of content: DR. ROBERT A CAVENEY MD (NPI 1306821772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306821772 NPI number — DR. ROBERT A CAVENEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVENEY
Provider First Name:
ROBERT
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
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:
1306821772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 EOFF ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-3823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-234-8663
Provider Business Mailing Address Fax Number:
304-234-8960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 CHAPLINE ST
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-3859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-243-1050
Provider Business Practice Location Address Fax Number:
304-243-0140
Provider Enumeration Date:
12/08/2005

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: 207X00000X , with the licence number:  12546 , 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: 0057551 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0097266000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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