Active NPI
Jeanne Marie Wahl, DO
- Family Medicine Physician
- Lewisburg, WV
National Provider Identifier
1942210513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2174
- Practice address
- 400 North Jefferson Street
Lewisburg, WV 24901 - Phone
- (304) 645-3220
- Fax
- (304) 645-4103
- NPI assigned
- Aug 8, 2006
- Last updated
- Nov 24, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2174 | WV | Primary |
Addresses
Primary practice location
400 North Jefferson Street
Lewisburg, WV 24901
Mailing address
400 North Jefferson Street
Lewisburg, WV 24901
Phone (304) 645-3220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810006064 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2174 | WV | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259020800000",
"number": "1942210513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 NORTH JEFFERSON STREET",
"city": "LEWISBURG",
"state": "WV",
"postal_code": "24901",
"telephone_number": "304-645-3220",
"fax_number": "304-645-4103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 NORTH JEFFERSON STREET",
"city": "LEWISBURG",
"state": "WV",
"postal_code": "24901",
"telephone_number": "304-645-3220",
"fax_number": "304-645-4103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHL",
"first_name": "JEANNE",
"middle_name": "MARIE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-08",
"last_updated": "2009-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "2174",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810006064",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lewisburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.