Provider Demographics
NPI:1639239593
Name:SPIEGEL, RICHARD M
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:SPIEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:7010 COAL RIVER RD
Mailing Address - City:COMFORT
Mailing Address - State:WV
Mailing Address - Zip Code:25049
Mailing Address - Country:US
Mailing Address - Phone:304-837-3003
Mailing Address - Fax:304-837-3004
Practice Address - Street 1:7010 COAL RIVER RD
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:WV
Practice Address - Zip Code:25049
Practice Address - Country:US
Practice Address - Phone:304-837-3003
Practice Address - Fax:304-837-3004
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV3189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134035000Medicaid