Provider Demographics
NPI:1639170020
Name:MILLIT, HENRY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:DAVID
Last Name:MILLIT
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 1:10 MEDICAL PARK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6389
Mailing Address - Country:US
Mailing Address - Phone:304-242-4800
Mailing Address - Fax:304-242-3580
Practice Address - Street 1:10 MEDICAL PARK
Practice Address - Street 2:SUITE 104
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6389
Practice Address - Country:US
Practice Address - Phone:304-242-4800
Practice Address - Fax:304-242-3580
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12316207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000563574OtherMOUNTAIN STATE BCBS
WV0087318000Medicaid
OH0531866Medicaid
12316COtherHEALTH PLAN OF UPPER OH V
151482200OtherFEDERAL WORKERS COMPENSAT
OH55068487100OtherOHIO BWC
WV55035705700OtherWV COMPENSATION
WV55035705700OtherWV COMPENSATION
WV7319061Medicare ID - Type Unspecified
OH0531866Medicaid
P00068052Medicare ID - Type UnspecifiedRAILROAD MEDICARE