Individual
EDWARD HENRY TILEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9 COURTNEY DR, CHARLESTON, WV 25304-2699
(304) 925-3115
(304) 925-2088
Mailing address
9 COURTNEY DR, CHARLESTON, WV 25304-2699
(304) 925-3115
(304) 925-2088
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
12774
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0128612000
—
WV
Enumeration date
09/21/2006
Last updated
07/23/2012
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