Healthcare Provider Details

I. General information

NPI: 1760434161
Provider Name (Legal Business Name): JOHN P LUBICKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/07/2023
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STADIUM DR
MORGANTOWN WV
26506
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE PO BOX 9196
MORGANTOWN WV
26506-9196
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-1312
  • Fax: 304-293-7042
Mailing address:
  • Phone: 304-293-1312
  • Fax: 304-293-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01061459A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: