Healthcare Provider Details

I. General information

NPI: 1730347402
Provider Name (Legal Business Name): THE MARTINSBURG WORK CENTER II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 INTEGRITY TER
MARTINSBURG WV
25405-3524
US

IV. Provider business mailing address

PO BOX 1265
MARTINSBURG WV
25402-1265
US

V. Phone/Fax

Practice location:
  • Phone: 304-262-9600
  • Fax: 304-262-6900
Mailing address:
  • Phone: 304-262-9600
  • Fax: 304-262-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberUD000018511001
License Number StateWV

VIII. Authorized Official

Name: BRYAN WITCHEY
Title or Position: DIRECTOR
Credential:
Phone: 304-262-9600