Individual
DR. JOHN N UDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
830 PENNSYLVANIA AVE, SUITE 103, CHARLESTON, WV 25302
(304) 388-1552
(304) 388-1577
Mailing address
PO BOX 7000, MORGANTOWN, WV 26507-7000
(304) 347-1290
(304) 347-1397
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
21878
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810001803
—
WV
Enumeration date
09/25/2006
Last updated
07/08/2007
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