Provider Demographics
NPI:1366516734
Name:WELDON, PATRICK OWEN (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:OWEN
Last Name:WELDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711841
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-720-8461
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-285-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008710L207L00000X
WV1691207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001706469OtherMSBCBS GROUP
WV270052997OtherWORKERS COMP
WV27005299700OtherWORKERS COMP
WV001907643OtherMSBCBS
WV005067000Medicaid
WV20554238700OtherTRICARE
WV3810006746Medicaid
WV020726000Medicaid
WVDF0767OtherRR MEDICARE
WVP00452518OtherRR MEDICARE
WV001960421OtherMSBCBS
PA1657557Medicaid
WV270052997004OtherTRICARE
WV001706470OtherMSBCBS GROUP
WV1071578OtherBRICKSTREET
WVG58976Medicare UPIN
PA1657557Medicaid
WV20554238700OtherTRICARE
WV270052997004OtherTRICARE
WV9364011Medicare PIN