Healthcare Provider Details

I. General information

NPI: 1174593065
Provider Name (Legal Business Name): WEDGEWOOD FAMILY PRACTICE & PSYCHIATRY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 VAN VOORHIS RD
MORGANTOWN WV
26505-3478
US

IV. Provider business mailing address

1197 VAN VOORHIS RD
MORGANTOWN WV
26505-3478
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-9400
  • Fax: 304-599-8917
Mailing address:
  • Phone: 304-599-9400
  • Fax: 304-599-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILBUR Z SINE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-599-9400