Provider Demographics
NPI:1265664957
Name:PEARSON, RICHARD JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD JOHN
Middle Name:C
Last Name:PEARSON
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 1:341 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5504
Mailing Address - Country:US
Mailing Address - Phone:304-292-8234
Mailing Address - Fax:304-284-0133
Practice Address - Street 1:341 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5504
Practice Address - Country:US
Practice Address - Phone:304-292-8234
Practice Address - Fax:304-284-0133
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine