Provider Demographics
NPI:1144283086
Name:VANPELT, BYRON L (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:L
Last Name:VANPELT
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:PO BOX 6042
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0703
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:20 MEDICAL PARK
Practice Address - Street 2:STE 303
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6390
Practice Address - Country:US
Practice Address - Phone:304-242-4646
Practice Address - Fax:304-242-4652
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09304207R00000X
OH35062608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0082498000Medicaid
OH0246764Medicaid
PA01764350Medicaid
OH0246764Medicaid
B42519Medicare UPIN