Provider Demographics
NPI:1871534131
Name:RIDDLE, MICHAEL P (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 1ST AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-525-6905
Mailing Address - Fax:304-525-4316
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-525-6905
Practice Address - Fax:304-525-4316
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01076363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1699732214OtherGROUP NPI
OHRIPA28561Medicare PIN
WV1699732214OtherGROUP NPI
WVRIPA24321Medicare PIN
WVQ35878Medicare UPIN