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Individual
MELVIN THEODORE VIDAL
Active
Individual
MELVIN THEODORE VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19970
WV
207R00000X
Internal Medicine Physician
202101772
NC
208M00000X
Hospitalist Physician
Primary
202101772
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706078
BLUE CROSS
WV
01
—
1471766-001
CIGNA
WV
05
—
6000357000
—
WV
01
—
7100067
AETNA
WV
01
—
875546
MAMSI
WV
01
—
P000095145
RAILROAD MEDICARE
WV
Enumeration date
09/20/2006
Last updated
03/08/2023
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