Provider Demographics
NPI:1235199480
Name:NEASE, DARREN BLAINE (MD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:BLAINE
Last Name:NEASE
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 1:1115 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-2071
Mailing Address - Country:US
Mailing Address - Phone:304-399-4121
Mailing Address - Fax:304-399-4126
Practice Address - Street 1:1115 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2071
Practice Address - Country:US
Practice Address - Phone:304-399-4121
Practice Address - Fax:304-399-4126
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21712208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001014Medicaid
KY64963994Medicaid
OH2125784Medicaid
WVG92391Medicare UPIN
WV3810001014Medicaid