Provider Demographics
NPI:1538261193
Name:NALLY, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:NALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:40 MEDICAL PARK
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-3880
Mailing Address - Fax:304-243-3895
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:SUITE 401
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-3880
Practice Address - Fax:304-243-3895
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2020-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV10408207K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042152000Medicaid
OH0181476Medicaid
WVA72146Medicare UPIN