Provider Demographics
NPI:1104823830
Name:BELCHER, MICHAEL LEE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:BELCHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX L-2667
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:304-256-0770
Mailing Address - Fax:304-256-0772
Practice Address - Street 1:230 GEORGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2620
Practice Address - Country:US
Practice Address - Phone:304-256-0770
Practice Address - Fax:304-256-0772
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV826363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVBEPA16592Medicare ID - Type Unspecified
WVP25524Medicare UPIN