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Organization
WHITEHALL MEDICAL PLLC
Active
Organization
WHITEHALL MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD E. VASICEK DO (MEMBER OWNER)
(304) 363-6600
Entity
Organization
Contact information
Practice address
177 MIDDLETOWN RD, SUITE 1, FAIRMONT, WV 26554-8216
(304) 363-6600
(304) 363-7700
Mailing address
177 MIDDLETOWN RD, SUITE 1, FAIRMONT, WV 26554-8216
(304) 363-6600
(304) 363-7700
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
1552
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001711083
GROUP BCBS
WV
01
—
2411485
GROUP
WV
05
—
3810006289
—
WV
Enumeration date
12/13/2006
Last updated
05/03/2012
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