Individual
MELCHOR F VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
27545 DANIEL BOONE PRKWY, RACINE, WV 25165
(304) 837-8637
Mailing address
PO BOX 4535, CHARLESTON, WV 25364-4535
(304) 837-8637
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
13443
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0049855001
—
WV
Enumeration date
09/06/2006
Last updated
07/08/2007
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