Provider Demographics
NPI:1730150251
Name:FERNALD, JOHN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:FERNALD
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 5427
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7505
Mailing Address - Country:US
Mailing Address - Phone:304-929-6930
Mailing Address - Fax:304-929-6935
Practice Address - Street 1:354 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-8985
Practice Address - Country:US
Practice Address - Phone:304-250-0150
Practice Address - Fax:304-250-0153
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234192208000000X
WV23655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013660Medicaid
WV4274991Medicare UPIN
WV3810013660Medicaid