Individual
TED THORNTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1418 MACCORKLE AVE SW STE A, CHARLESTON, WV 25303-1331
(304) 348-1419
Mailing address
10 HIGH MEADOW DR, CHARLESTON, WV 25311-9734
(304) 343-4261
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
14747
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0041288000
—
WV
05
—
3810012081
—
WV
Enumeration date
07/28/2006
Last updated
02/26/2013
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