Provider Demographics
NPI:1598792202
Name:RIFFE, DELBERTA S (NP)
Entity Type:Individual
Prefix:
First Name:DELBERTA
Middle Name:S
Last Name:RIFFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 6TH AVE SW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1242
Mailing Address - Country:US
Mailing Address - Phone:304-744-4532
Mailing Address - Fax:304-744-3219
Practice Address - Street 1:312 6TH AVE SW
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1242
Practice Address - Country:US
Practice Address - Phone:304-744-4532
Practice Address - Fax:304-744-3219
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0161245001Medicaid
WVNP07081Medicare ID - Type Unspecified
WV0161245001Medicaid