Provider Demographics
NPI:1144499401
Name:SIDNEY C. LERFALD, MD
Entity type:Organization
Organization Name:SIDNEY C. LERFALD, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LERFALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-343-1022
Mailing Address - Street 1:415 MORRIS ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1842
Mailing Address - Country:US
Mailing Address - Phone:304-343-1022
Mailing Address - Fax:304-720-8286
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 306
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1842
Practice Address - Country:US
Practice Address - Phone:304-343-1022
Practice Address - Fax:304-720-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012605Medicaid