Provider Demographics
NPI:1801639125
Name:TEMPLETON, DYLAN ELIJAH (IDMT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:ELIJAH
Last Name:TEMPLETON
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 WRIGHTS RUN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-8352
Mailing Address - Country:US
Mailing Address - Phone:304-480-9292
Mailing Address - Fax:
Practice Address - Street 1:641 WRIGHTS RUN RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-8352
Practice Address - Country:US
Practice Address - Phone:304-480-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians