Provider Demographics
NPI:1821152182
Name:MCDEVITT, BRIAN JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:MCDEVITT
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 99
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-0099
Mailing Address - Country:US
Mailing Address - Phone:304-855-4000
Mailing Address - Fax:304-855-1067
Practice Address - Street 1:CHAPMANVILLE MEDICAL CENTER
Practice Address - Street 2:384 MAIN STREET
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-4000
Practice Address - Fax:304-855-1067
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1665207QA0401X, 207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5305014000Medicaid
513904Medicare ID - Type Unspecified
G95903Medicare UPIN