Provider Demographics
NPI:1659467413
Name:TRAMMELL, S WILLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:WILLIS
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-347-1290
Mailing Address - Fax:304-347-1397
Practice Address - Street 1:1201 WASHINGTON STREET E
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-388-7270
Practice Address - Fax:304-388-7280
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-10-08
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Provider Licenses
StateLicense IDTaxonomies
WV11508208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0127907000Medicaid
WV0127907000Medicaid
B42556Medicare UPIN