Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 001222 | WV |
NPI | 1912007402 |
---|---|
Provider Name | Todd A Warner |
First Address | Charleston, WV 25304-1840 |
Second Address | Charleston, WV 25304-1840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 18/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7305206000 | (05) | WV |