Provider Demographics
NPI:1447237250
Name:MCWHORTER, RICHARD ELLISON (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ELLISON
Last Name:MCWHORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:RADIOLOGY INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:5221 US ROUTE 60 E
Practice Address - Street 2:RADIOLOGY INC
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2022
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV131562085R0202X
KY317752085R0202X
OH35-08-1070-M2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000500531OtherMTN STATE BC BS
OH0507544Medicaid
KY50007242OtherPASSPORT
WV550493376 00OtherWORKMANS COMP
KYP00766041OtherRR MEDICARE (KY)
WV0117579000Medicaid
OH000000196558OtherUNISON
KY6469935800Medicaid
WV300021803OtherRR MEDICARE (WV)
4334342OtherAETNA
WV300021803OtherRR MEDICARE (WV)
E19499Medicare UPIN
KYP00766041OtherRR MEDICARE (KY)
WV0117579000Medicaid