Provider Demographics
NPI:1699766923
Name:TAUBENSLAG, WALTER NEAL (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:NEAL
Last Name:TAUBENSLAG
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:20 MEDICAL PARK
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6390
Mailing Address - Country:US
Mailing Address - Phone:304-243-1412
Mailing Address - Fax:304-243-1414
Practice Address - Street 1:20 MEDICAL PARK
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6390
Practice Address - Country:US
Practice Address - Phone:304-243-1412
Practice Address - Fax:304-243-1414
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV14389208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVTA0613792OtherMEDICARE ID NUMBER
OH2526681Medicaid
WV0130237000Medicaid
WVA72599Medicare UPIN