Healthcare Provider Details

I. General information

NPI: 1003794181
Provider Name (Legal Business Name): WVU MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOUNDATION WAY STE 3300
MARTINSBURG WV
25401-9198
US

IV. Provider business mailing address

PO BOX 780
MORGANTOWN WV
26507-0780
US

V. Phone/Fax

Practice location:
  • Phone: 304-264-1314
  • Fax: 304-264-1291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN GIBSON
Title or Position: VP OF FINANCE
Credential:
Phone: 304-598-4256