Healthcare Provider Details

I. General information

NPI: 1972954485
Provider Name (Legal Business Name): ANDREW MORGAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE CAMC MEMORIAL HOSPITAL
CHARLESTON WV
25304
US

IV. Provider business mailing address

501 MORRIS STREET PO BOX 1547
CHARLESTON WV
25326-1547
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7170
  • Fax:
Mailing address:
  • Phone: 304-388-6004
  • Fax: 304-388-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3240
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: