Individual
TEODORO G MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 CHENOWETH DR STE A, BRIDGEPORT, WV 26330-1688
(304) 842-5449
(304) 842-5440
Mailing address
PO BOX 881, BRIDGEPORT, WV 26330-0881
(304) 842-5449
(304) 842-5440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
12904
WV
207RG0100X
Gastroenterology Physician
Primary
12904
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0083622000
—
WV
Enumeration date
05/25/2006
Last updated
11/07/2007
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