Healthcare Provider Details

I. General information

NPI: 1245437979
Provider Name (Legal Business Name): AMANDA COMBS PRINCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KAYE COMBS M.D.

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5047 GERRARDSTOWN RD STE 2B
INWOOD WV
25428-3951
US

IV. Provider business mailing address

2500 FOUNDATION WAY
MARTINSBURG WV
25401-9000
US

V. Phone/Fax

Practice location:
  • Phone: 304-821-1444
  • Fax: 304-821-1450
Mailing address:
  • Phone: 304-264-9202
  • Fax: 304-264-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFC1277169
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23193
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: