Healthcare Provider Details

I. General information

NPI: 1225009525
Provider Name (Legal Business Name): VINCENT PAUL KOLANKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MON HEALTH MEDICAL PARK DR STE 1201
MORGANTOWN WV
26505
US

IV. Provider business mailing address

1428 WESTERN AVE
MORGANTOWN WV
26505-2137
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14035
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14035
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: