Provider Demographics
NPI:1194256644
Name:HATFIELD, WESLEY A (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:A
Last Name:HATFIELD
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 1:3448 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2906
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:3448 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2906
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-1073
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV327192085R0202X
KY567302085R0202X
OH35.1485382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100542900Medicaid
WV1194256644Medicaid
OH0021844Medicaid