Provider Demographics
NPI:1053381509
Name:DEL-CHECCOLO, RICHARD LAYNE (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LAYNE
Last Name:DEL-CHECCOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2302
Mailing Address - Country:US
Mailing Address - Phone:304-523-8971
Mailing Address - Fax:
Practice Address - Street 1:31ST ST MEDICAL CLINIC
Practice Address - Street 2:410 31ST ST
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-525-9100
Practice Address - Fax:304-525-4402
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV13119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00132493OtherMOUNTAIN STATE BLUE CROSS
WV0050362000Medicaid
WV207955OtherCARELINK
WV4119781Medicare PIN
WV207955OtherCARELINK