Provider Demographics
NPI:1972606812
Name:PICCIRILLO, RICHARD ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ELLIOT
Last Name:PICCIRILLO
Suffix:
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:CENTRAL WV MEDCORP INC
Mailing Address - Street 2:PO BOX 2630
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2630
Mailing Address - Country:US
Mailing Address - Phone:304-636-7451
Mailing Address - Fax:304-637-2007
Practice Address - Street 1:62 BARNARD AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3150
Practice Address - Country:US
Practice Address - Phone:304-636-7451
Practice Address - Fax:304-637-2007
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000139958OtherBCBS PROVIDER NUMBER
WVWV09937AOtherHEALTH PLAN PROVIDER NBR
WV0082929001Medicaid
WVA71925Medicare UPIN
WV0082929001Medicaid
WVPI 0415151Medicare PIN