Individual
TERRY L STAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 MEDICAL PARK, WHEELING, WV 26003-6379
(304) 243-3270
Mailing address
PO BOX 5307, LIMA, OH 45802-5307
(419) 224-5707
(419) 229-0040
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
14313
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000864293
MT STATE BCBS
WV
05
—
0117198000
—
WV
05
—
0222011
—
OH
01
—
14313A
HEALTH PLAN OF UPPER OH V
—
01
—
300040909
RAILROAD MEDICARE
OH
01
—
300117903
RAILROAD MEDICARE
WV
Enumeration date
03/03/2006
Last updated
07/08/2011
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