Provider Demographics
NPI:1154409092
Name:HUNTINGTON MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:HUNTINGTON MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-529-0900
Mailing Address - Street 1:1934 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3722
Mailing Address - Country:US
Mailing Address - Phone:304-529-0900
Mailing Address - Fax:304-529-3913
Practice Address - Street 1:1934 11TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3722
Practice Address - Country:US
Practice Address - Phone:304-529-0900
Practice Address - Fax:304-529-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10775207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070244000Medicaid
WV0070244000Medicaid
0426263Medicare ID - Type Unspecified