Provider Demographics
NPI:1467458778
Name:ORVIK, BENNETT D (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:D
Last Name:ORVIK
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 1:25 GARTON PLZ
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-2128
Mailing Address - Country:US
Mailing Address - Phone:304-269-6620
Mailing Address - Fax:304-269-4593
Practice Address - Street 1:25 GARTON PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2128
Practice Address - Country:US
Practice Address - Phone:304-269-6620
Practice Address - Fax:304-269-4593
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055675000Medicaid
WVA72000Medicare UPIN
WVWV4989BMedicare PIN
WV0055675000Medicaid