Provider Demographics
NPI:1710079595
Name:RICHARD L DEL CHECCOLO MD INC
Entity Type:Organization
Organization Name:RICHARD L DEL CHECCOLO MD INC
Other - Org Name:31ST STREET MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:DEL CHECCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-525-9100
Mailing Address - Street 1:410 31ST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1420
Mailing Address - Country:US
Mailing Address - Phone:304-525-9100
Mailing Address - Fax:304-525-4402
Practice Address - Street 1:410 31ST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1420
Practice Address - Country:US
Practice Address - Phone:304-525-9100
Practice Address - Fax:304-525-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001713811OtherMOUNTAIN STATE BCBS
WV0050362000Medicaid
WV0050362000Medicaid
WV9338961Medicare PIN