Provider Demographics
NPI:1760443162
Name:PAINE, ALBERT JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JAMES
Last Name:PAINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6765
Mailing Address - Country:US
Mailing Address - Phone:304-255-2341
Mailing Address - Fax:304-255-2343
Practice Address - Street 1:78 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6765
Practice Address - Country:US
Practice Address - Phone:304-255-2341
Practice Address - Fax:304-255-2343
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13309207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0101166000Medicaid
WV0101166000Medicaid
WV010021491Medicare PIN
WV010021491Medicare PIN