Provider Demographics
NPI:1043209687
Name:FERNAU, JAMES L (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:FERNAU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1448 10TH AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-6381
Mailing Address - Fax:304-691-8591
Practice Address - Street 1:3246 US ROUTE 60
Practice Address - Street 2:SUITE 26
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2076
Practice Address - Country:US
Practice Address - Phone:304-691-8910
Practice Address - Fax:304-691-1860
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2025-01-16
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Provider Licenses
StateLicense IDTaxonomies
PAMD040888E208200000X
WV17547208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0100698000Medicaid
OH0134143Medicaid
PA188667RB7Medicare PIN
F67445Medicare UPIN