Provider Demographics
NPI:1083656516
Name:R.TODD DEPOND, MD, PLLC
Entity Type:Organization
Organization Name:R.TODD DEPOND, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:DEPOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-345-4525
Mailing Address - Street 1:400 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1652
Mailing Address - Country:US
Mailing Address - Phone:304-345-4525
Mailing Address - Fax:304-345-4527
Practice Address - Street 1:400 COURT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1652
Practice Address - Country:US
Practice Address - Phone:304-345-4525
Practice Address - Fax:304-345-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16935207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1205804374OtherNPI NUMBER
WV1205804374OtherNPI NUMBER