Provider Demographics
NPI:1376595702
Name:CHURCH, DAVID H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:CHURCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:527 MEDICAL PARK DR STE 304
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9010
Mailing Address - Country:US
Mailing Address - Phone:304-933-3830
Mailing Address - Fax:304-933-3837
Practice Address - Street 1:527 MEDICAL PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-933-3830
Practice Address - Fax:304-933-3837
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV14739207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV14739AOtherHEALTH PLAN
WV000044189OtherBLUE CROSS BLUE SHIELD
WV0070525000Medicaid
WV000044189OtherBLUE CROSS BLUE SHIELD
WVC95932Medicare UPIN
WV9919981Medicare PIN