Provider Demographics
NPI:1063663896
Name:DRM INC
Entity Type:Organization
Organization Name:DRM INC
Other - Org Name:APPALACHIAN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DI CRISTOFARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-757-7788
Mailing Address - Street 1:104 STATION PLACE WAY
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8747
Mailing Address - Country:US
Mailing Address - Phone:304-757-7788
Mailing Address - Fax:304-201-1140
Practice Address - Street 1:104 STATION PLACE WAY
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8747
Practice Address - Country:US
Practice Address - Phone:304-757-7788
Practice Address - Fax:304-201-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP004544951041C0700X
WV19679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty