Healthcare Provider Details

I. General information

NPI: 1992877872
Provider Name (Legal Business Name): BONHOMME JOSEPH PRUD'HOMME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26507-0897
US

IV. Provider business mailing address

PO BOX 897
MORGANTOWN WV
26507-0897
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4800
  • Fax:
Mailing address:
  • Phone: 304-293-7401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number18188
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number18188
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: