Provider Demographics
NPI:1255394300
Name:OVERMILLER, CARL LEE (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:LEE
Last Name:OVERMILLER
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:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-0587
Mailing Address - Country:US
Mailing Address - Phone:304-373-0133
Mailing Address - Fax:304-373-0497
Practice Address - Street 1:122 PINNELL ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9101
Practice Address - Country:US
Practice Address - Phone:304-373-0133
Practice Address - Fax:304-373-1598
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17934208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV437312OtherCARELINK
WV794702OtherFIRST HEALTH
OH2697550Medicaid
VA010299772Medicaid
WV57898OtherUNICARE
WV1801280000Medicaid
WV4539316OtherAETNA
WV000787284OtherMOUNTAIN BCBS
WV2243174OtherCIGNA
WV57898OtherUNICARE
WV4539316OtherAETNA
WVF92057Medicare UPIN