| Organization Name: | WHITEHALL MEDICAL PLLC |
| NPI Number: | 1659432631 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD E. VASICEK (MEMBER OWNER) |
| Mailing Address: | 177 Middletown Rd Suite 1 Fairmont |
| State: | WV US |
| Postal Code: | 265548216 |
| Phone Number: | 3043636600 |
| Fax Number: | 3043637700 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 05/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 1552 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |