Healthcare Provider Details

I. General information

NPI: 1174602924
Provider Name (Legal Business Name): ROBERT WARREN HULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MON HEALTH MEDICAL PARK DR STE 2300
MORGANTOWN WV
26505-1134
US

IV. Provider business mailing address

2000 MON HEALTH MEDICAL PARK DR STE 2300
MORGANTOWN WV
26505-1134
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-8802
  • Fax: 304-599-5607
Mailing address:
  • Phone: 304-599-8802
  • Fax: 304-599-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number16949
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number17022
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: