Provider Demographics
NPI:1215195615
Name:SAULLE, DWIGHT (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
Last Name:SAULLE
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:PO BOX 4190
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4190
Mailing Address - Country:US
Mailing Address - Phone:304-399-4405
Mailing Address - Fax:304-399-2526
Practice Address - Street 1:2860 3RD AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1454
Practice Address - Country:US
Practice Address - Phone:304-525-6825
Practice Address - Fax:304-525-0300
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25975207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106256Medicaid
WV3810027553Medicaid
OH0106256Medicaid