Healthcare Provider Details

I. General information

NPI: 1083173090
Provider Name (Legal Business Name): TREY WILLIAM VANEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

6 FLATTS LN
MORGANTOWN WV
26505-3840
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number30649
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: