Provider Demographics
NPI:1740275676
Name:HESS, DAVID ELWOOD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELWOOD
Last Name:HESS
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 1:215 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1748
Mailing Address - Country:US
Mailing Address - Phone:304-842-6645
Mailing Address - Fax:304-842-4909
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1748
Practice Address - Country:US
Practice Address - Phone:304-842-6645
Practice Address - Fax:304-842-4909
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV080056363Medicare PIN
WVF77878Medicare UPIN
WV9308531Medicare PIN