Provider Demographics
NPI:1710912498
Name:CHALIFOUX JR, ROLAND F (DO)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:F
Last Name:CHALIFOUX JR
Suffix:
Gender:M
Credentials:DO
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 6115
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0737
Mailing Address - Country:US
Mailing Address - Phone:304-242-4004
Mailing Address - Fax:304-242-8004
Practice Address - Street 1:90 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:304-242-4004
Practice Address - Fax:304-242-8004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2077208VP0014X
OH34.016792208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004422Medicaid
OH2625001Medicaid
WV4165832Medicare PIN
WVE49567Medicare UPIN