Provider Demographics
NPI:1427516129
Name:PARKERSBURG INFECTIOUS DISEASE PLLC
Entity type:Organization
Organization Name:PARKERSBURG INFECTIOUS DISEASE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEYOUM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-916-1288
Mailing Address - Street 1:800 GRAND CENTRAL MALL STE 10
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4100
Mailing Address - Country:US
Mailing Address - Phone:304-916-1288
Mailing Address - Fax:304-916-1289
Practice Address - Street 1:800 GRAND CENTRAL MALL STE 10
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-916-1288
Practice Address - Fax:304-916-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty