Provider Demographics
NPI:1134172497
Name:HARPOLD, ROBERT MORRIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MORRIS
Last Name:HARPOLD
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 1:707 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1742
Mailing Address - Country:US
Mailing Address - Phone:304-345-0530
Mailing Address - Fax:
Practice Address - Street 1:3953 S NOVA RD STE B
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4910
Practice Address - Country:US
Practice Address - Phone:386-788-4911
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139708207R00000X
WV21529208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008144Medicaid
WV3810024049 (GROUP)Medicaid
WVI24105Medicare UPIN
WVWV1722B441Medicare PIN
WVB441 (THSPP GROUP)Medicare PIN