MEDICARE: BRYAN K. STUCHELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	19964	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	WV19964B	OTHER	WV	HEALTH PLAN
3	550783964004	OTHER	WV	MT STATE BCBS

General Provider Information

NPI Number	:	1558360610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN K. STUCHELL M.D.

Provider Business Mailing Address
First Line	:	63 WHARF ST
Second Line	:	SUITE 100
City	:	MORGANTOWN
State	:	WV
Zip	:	26501-5937
Country	:	US
Telephone Number	:	304-291-3627
Fax Number	:	304-598-3630

Provider Business Practice Location Address
First Line	:	63 WHARF ST
Second Line	:	SUITE 100
City	:	MORGANTOWN
State	:	WV
Zip	:	26501-5937
Country	:	US
Telephone Number	:	304-291-3627
Fax Number	:	304-598-3630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	05/06/2011

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