Provider Demographics
NPI:1205442050
Name:FLANERY, PATRICK J
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:FLANERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-2377
Mailing Address - Country:US
Mailing Address - Phone:304-612-7457
Mailing Address - Fax:
Practice Address - Street 1:1005 1ST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2377
Practice Address - Country:US
Practice Address - Phone:304-612-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant