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Individual

ALAN LOUIS DESMOND

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
AUD CCC-A

Contact information

Practice address
508 NEW HOPE ROAD, SUITE #19, PRINCETON, WV 24740-2272
(304) 487-2487
(304) 431-3367
Mailing address
508 NEW HOPE ROAD, SUITE #19, PRINCETON, WV 24740-2272
(304) 487-2487
(304) 431-3367

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
2201000219
VA
231H00000X
Audiologist
447
WV
231H00000X
Audiologist
Primary
A0074
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
640000237
RR MEDICARE PALMETTO GBA
05
9450513
VA
05
9460000000
WV
01
DE0534282
PALMETTO GBA MEDICARE PTAN NUMBER PCTN OFFICE
01
DE0534283
PALMETTO GBA MEDICARE PTAN NUMBER BLFD OFFICE
Enumeration date
03/14/2006
Last updated
05/23/2013
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