Healthcare Provider Details

I. General information

NPI: 1386655538
Provider Name (Legal Business Name): THOMAS W BARTSCH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DRIVE
CLARKSBURG WV
26301
US

IV. Provider business mailing address

3304 DARRAH AVE
MORGANTOWN WV
26508-9187
US

V. Phone/Fax

Practice location:
  • Phone: 304-626-7709
  • Fax: 304-626-7010
Mailing address:
  • Phone: 304-292-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00301
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: