Provider Demographics
NPI:1043484629
Name:WEST VIRGINIA WEIGHT AND WELLNESS
Entity Type:Organization
Organization Name:WEST VIRGINIA WEIGHT AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-267-8300
Mailing Address - Street 1:37 VERONICA DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-3756
Mailing Address - Country:US
Mailing Address - Phone:304-267-8300
Mailing Address - Fax:304-267-8301
Practice Address - Street 1:37 VERONICA DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3756
Practice Address - Country:US
Practice Address - Phone:304-267-8300
Practice Address - Fax:304-267-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19195261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service