Provider Demographics
NPI:1508868043
Name:SOULSBY, DAVID LEON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEON
Last Name:SOULSBY
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 1:138 LESLIE PL
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-8902
Mailing Address - Country:US
Mailing Address - Phone:304-757-2476
Mailing Address - Fax:
Practice Address - Street 1:610 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1251
Practice Address - Country:US
Practice Address - Phone:304-766-7515
Practice Address - Fax:304-766-7566
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13599207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000503590OtherBCBS WEST VIRGINIA
WV0097603000Medicaid
WVSO0705962Medicare ID - Type Unspecified
WV000503590OtherBCBS WEST VIRGINIA