Organization
MELVIN T VIDAL MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELVIN T VIDAL MD (OWNER)
(304) 720-2060
Entity
Organization
Contact information
Practice address
1313 QUARRIER ST, CHARLESTON, WV 25301-6002
(304) 720-2060
Mailing address
PO BOX 1055, SCOTT DEPOT, WV 25560-1055
(304) 720-2060
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19970
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706078
BCBS
WV
01
—
110217977
RR MEDICARE
WV
05
—
3810010643
—
WV
01
—
DB2539
FEDERAL BLACK LUNG
WV
Enumeration date
04/25/2007
Last updated
11/02/2012
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