Provider Demographics
NPI:1225397508
Name:ROBERT M. HARPOLD, MD, PLLC
Entity Type:Organization
Organization Name:ROBERT M. HARPOLD, 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:MORRIS
Authorized Official - Last Name:HARPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-720-3600
Mailing Address - Street 1:3418 STANTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-720-3600
Mailing Address - Fax:304-720-3602
Practice Address - Street 1:3418 STANTON AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-720-3600
Practice Address - Fax:304-720-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008144Medicaid
WVI24105Medicare UPIN
WV3810008144Medicaid