Provider Demographics
NPI:1124001920
Name:FELTON, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:FELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ROANE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2334
Mailing Address - Country:US
Mailing Address - Phone:304-344-0096
Mailing Address - Fax:304-342-4725
Practice Address - Street 1:110 ROANE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2334
Practice Address - Country:US
Practice Address - Phone:304-344-0096
Practice Address - Fax:304-342-4725
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15243207L00000X
WI42289-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0124527000Medicaid
WV0207026000OtherMEDICAID GROUP
WV9333201OtherMEDICARE GROUP
WV9333201OtherMEDICARE GROUP
WIC35195Medicare UPIN
WV0207026000OtherMEDICAID GROUP
WV9333201OtherMEDICARE GROUP
WVWV0715BMedicare PIN