Healthcare Provider Details

I. General information

NPI: 1568471480
Provider Name (Legal Business Name): PAUL RICHARD OGERSHOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 7TH ST
WAYNESBURG PA
15370-1660
US

IV. Provider business mailing address

125 N 6TH ST
CLARKSBURG WV
26301-2665
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-2395
  • Fax: 724-627-2610
Mailing address:
  • Phone: 304-624-7200
  • Fax: 304-554-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD060665L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number18887
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: