Provider Demographics
NPI:1679740385
Name:THOMAS A. DURNELL, MD INC
Entity type:Organization
Organization Name:THOMAS A. DURNELL, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-424-2088
Mailing Address - Street 1:705 GARFIELD AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5444
Mailing Address - Country:US
Mailing Address - Phone:304-424-2088
Mailing Address - Fax:304-424-2059
Practice Address - Street 1:705 GARFIELD AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5444
Practice Address - Country:US
Practice Address - Phone:304-424-2088
Practice Address - Fax:304-424-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14026207V00000X
OH35.046188207V00000X
FLME85347207V00000X
SC19268207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001723715OtherMT STATE BLUE CROSS BLUE SHIELD
WVTH9258701Medicare PIN