Provider Demographics
NPI:1386627743
Name:RADCLIFFE, ERIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:RADCLIFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:527 MEDICAL PARK DR STE 500
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:681-342-3600
Mailing Address - Fax:681-342-3625
Practice Address - Street 1:527 MEDICAL PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9010
Practice Address - Country:US
Practice Address - Phone:681-342-3600
Practice Address - Fax:681-342-3625
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2116270OtherALLIANCE
WVWV16836AOtherHEALTH PLAN #
WV080128624OtherRAILROAD MEDICARE #
WV001718907OtherBLUECROSSBLUESHIELD #
WV0053261000Medicaid
WV206377OtherCARELINK/COVENTRY #
WV8116270OtherMAMSI PROVIDER #
WVWV16836AOtherHEALTH PLAN #
WV080128624OtherRAILROAD MEDICARE #
WV0053261000Medicaid