Provider Demographics
NPI:1184625691
Name:NIESS, DENNIS RICHARD (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:RICHARD
Last Name:NIESS
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 1:20 MEDICAL PARK
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6390
Mailing Address - Country:US
Mailing Address - Phone:304-243-7030
Mailing Address - Fax:304-243-4282
Practice Address - Street 1:20 MEDICAL PARK
Practice Address - Street 2:SUITE 306
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6390
Practice Address - Country:US
Practice Address - Phone:304-243-7030
Practice Address - Fax:304-243-4282
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH55068028400OtherOHIO BWC
12719DOtherHEALTH PLAN OF UPPER OH V
OH0530027Medicaid
A72170Medicare UPIN
12719DOtherHEALTH PLAN OF UPPER OH V