Basic Information
| Provider Information | |||||||||
| NPI: | 1609843960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALDIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WARNER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4911 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | SHEPHERDSTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254435066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048766346 | ||||||||
| FaxNumber: | 3016192312 | ||||||||
| Practice Location | |||||||||
| Address1: | 171 TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | HARPERS FERRY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254253641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045356343 | ||||||||
| FaxNumber: | 3045356618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 20707 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | 20707 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1609843960 | 05 | WV | MEDICAID |