Organization
HAVEN N WALL JR MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAVEN N WALL MD (PRESIDENT)
(304) 645-6083
Entity
Organization
Contact information
Practice address
RR 2 BOX 171C, LEWISBURG, WV 24901-9318
(304) 645-6083
Mailing address
PO BOX 1046, LEWISBURG, WV 24901-4046
(304) 645-6083
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
12141
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0087282000
—
WV
Enumeration date
02/23/2007
Last updated
05/14/2010
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