Provider Demographics
NPI:1083394555
Name:NAHODIL, COREY BLAKE
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:BLAKE
Last Name:NAHODIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 26TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-1110
Mailing Address - Country:US
Mailing Address - Phone:681-268-4051
Mailing Address - Fax:
Practice Address - Street 1:630 8TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2633
Practice Address - Country:US
Practice Address - Phone:304-962-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist