Healthcare Provider Details

I. General information

NPI: 1992949358
Provider Name (Legal Business Name): BRADLEY ALAN THURO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

261 PALISADES DR
MORGANTOWN WV
26508-9009
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-6925
  • Fax:
Mailing address:
  • Phone: 501-773-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number26911
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number26911
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: