Provider Demographics
NPI:1922011063
Name:RANDALL P WEYRICH MD APMC
Entity Type:Organization
Organization Name:RANDALL P WEYRICH MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WEYRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-843-1433
Mailing Address - Street 1:426 8TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1451
Mailing Address - Country:US
Mailing Address - Phone:304-843-1433
Mailing Address - Fax:304-843-6956
Practice Address - Street 1:426 8TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-843-1433
Practice Address - Fax:304-843-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV009633207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9331631Medicare ID - Type Unspecified