1932141991 NPI number — DR. PATRICK P DUGAN M.D.

Table of content: DR. PATRICK P DUGAN M.D. (NPI 1932141991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932141991 NPI number — DR. PATRICK P DUGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUGAN
Provider First Name:
PATRICK
Provider Middle Name:
P
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:
1932141991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 ANN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-5122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-424-4593
Provider Business Mailing Address Fax Number:
304-424-4017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 ANN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-5122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-865-5155
Provider Business Practice Location Address Fax Number:
304-865-5156
Provider Enumeration Date:
06/12/2006

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: 208800000X , with the licence number:  20069 , 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: 340017849 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 007479117 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2298704 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001720892 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7500043000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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