Provider Demographics
NPI:1508969429
Name:TALKINGTON, ANDREW ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALAN
Last Name:TALKINGTON
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 1:1 MED CENTER DR
Mailing Address - Street 2:LOUIS A JOHNSON VA MEDICAL CENTER
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4155
Mailing Address - Country:US
Mailing Address - Phone:304-622-3346
Mailing Address - Fax:
Practice Address - Street 1:1 MED CENTER DR
Practice Address - Street 2:LOUIS A JOHNSON VA MEDICAL CENTER
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4155
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0044979001Medicaid
WV1508969429OtherMOUNTAIN STATE BCBS
WVWV17497AOtherHEALTH PLAN PROVIDER NBR
WV001721760OtherMOUNTAIN STATE BCBS SERVICE PROV. #
WV0044979001Medicaid
WVTA0847602Medicare PIN
WVWV17497AOtherHEALTH PLAN PROVIDER NBR