Organization
RHEUMATOLOGY AND PULMONARY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BECKY S FONDALE (OFFICE MANAGER)
(304) 256-0242
Entity
Organization
Contact information
Practice address
421 CARRIAGE DR, BECKLEY, WV 25801-2805
(304) 256-0242
(304) 256-0244
Mailing address
421 CARRIAGE DR, BECKLEY, WV 25801-2805
(304) 256-0242
(304) 256-0244
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17491
WV
174400000X
Specialist
18402
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001711048
BLUE CROSS
WV
05
—
1801602000
—
WV
05
—
1805604000
—
WV
Enumeration date
12/30/2005
Last updated
05/13/2011
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