Provider Demographics
NPI:1902800931
Name:RASMUSSEN, NORVAL L (MD)
Entity Type:Individual
Prefix:
First Name:NORVAL
Middle Name:L
Last Name:RASMUSSEN
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 1:1526 MILEGROUND RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3745
Mailing Address - Country:US
Mailing Address - Phone:304-296-2395
Mailing Address - Fax:304-413-0055
Practice Address - Street 1:1526 MILEGROUND RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3745
Practice Address - Country:US
Practice Address - Phone:304-292-4996
Practice Address - Fax:304-292-9578
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11609208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0050271000Medicaid
010064707OtherRAILROAD MEDICARE
WVCB6236OtherRAILROAD MEDICARE GROUP
017821900OtherFED. BLACK LUNG
WV001721628OtherBLUE SHIELD SERVICE #
010064707OtherRAILROAD MEDICARE
WV0050271000Medicaid
WV001721628OtherBLUE SHIELD SERVICE #