1760461164 NPI number — DR. KELLI J DUMM MD

Table of content: DR. KELLI J DUMM MD (NPI 1760461164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760461164 NPI number — DR. KELLI J DUMM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMM
Provider First Name:
KELLI
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1760461164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENTON DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25311-1263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-346-5533
Provider Business Mailing Address Fax Number:
304-346-5611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 KENTON DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25311-1263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-346-5533
Provider Business Practice Location Address Fax Number:
304-346-5611
Provider Enumeration Date:
01/13/2006

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: 207R00000X , with the licence number:  21170 , 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: 1447349238 . This is a "NPI NUMBER FOR GROUP PRACTICE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: DC7713 . This is a "UMWA GROUP NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001706175 . This is a "BLUE CROSS NUMBER FOR GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00189318 . This is a "UMWA PIN NUMBER FOR GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00215125 . This is a "RAILROAD NUMBER FOR GROUP PRACTICE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810001081 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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