Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 12507 | WV |
NPI | 1093828725 |
---|---|
Provider Name | Dr. Elliott W Chideckel |
First Address | Morgantown, WV 26507-0897 |
Second Address | Morgantown, WV 26506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 13/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008425230001 | (05) | PA |
0083413000 | (05) | WV |
061191300 | (05) | MD |
460000785 | RAILROAD MEDICARE (01) | WV |
A66930 | (02) | WV |