Medina, Teodoro G

Medina, Teodoro G is an individual health care provider with primary practice located at 2 Chenoweth Dr Ste A , Bridgeport WV 26330-1688. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gastroenterology, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Gastroenterology is his primary health care specialty. Medina, Teodoro G can be contacted via phone (304) 842-5449.

Contact Information

Primary practice address
2 Chenoweth Dr Ste A Bridgeport WV 26330-1688
Fax: (304) 842-5440
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 12904 West Virginia
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 12904 West Virginia

Profile Details

NPI number 1134175094
LBN Legal business name Medina, Teodoro G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Nov 7th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134175094 NPPES
West Virginia MEDICAID 0083622000

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