Provider Demographics
NPI:1972783967
Name:DAVID M. NALLY, M.D.
Entity Type:Organization
Organization Name:DAVID M. NALLY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:NALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-845-4340
Mailing Address - Street 1:426 8TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1451
Mailing Address - Country:US
Mailing Address - Phone:304-845-4340
Mailing Address - Fax:
Practice Address - Street 1:426 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-845-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042152000Medicaid
WV0042152000Medicaid
WV0501744Medicare PIN