Provider Demographics
NPI:1356327951
Name:VIDAL, EDUARDO MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:MIGUEL
Last Name:VIDAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 HAL GREER BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4114
Mailing Address - Country:US
Mailing Address - Phone:304-691-1930
Mailing Address - Fax:
Practice Address - Street 1:1400 HAL GREER BLVD FL 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4114
Practice Address - Country:US
Practice Address - Phone:304-691-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83671207ND0101X
WV30229207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery