Provider Demographics
NPI:1699820415
Name:DAVID A CIAROLLA, MD, INC
Entity Type:Organization
Organization Name:DAVID A CIAROLLA, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CIAROLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-363-7990
Mailing Address - Street 1:1228 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2369
Mailing Address - Country:US
Mailing Address - Phone:304-363-7990
Mailing Address - Fax:304-363-7997
Practice Address - Street 1:1228 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2369
Practice Address - Country:US
Practice Address - Phone:304-363-7990
Practice Address - Fax:304-363-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV17859207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0088242001Medicaid
WV0088242001Medicaid
WV9340071Medicare PIN