Healthcare Provider Details

I. General information

NPI: 1063491900
Provider Name (Legal Business Name): VAMC MARTINSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE
MARTINSBURG WV
25401-9990
US

IV. Provider business mailing address

510 BUTLER AVE
MARTINSBURG WV
25401-9990
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax: 304-262-4841
Mailing address:
  • Phone: 304-263-0811
  • Fax: 304-262-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCP00139149
License Number StateWV

VIII. Authorized Official

Name: DR. LINDA A MORRIS
Title or Position: CHIEF OF STAFF
Credential: M.D.
Phone: 304-263-0811