Healthcare Provider Details

I. General information

NPI: 1760577027
Provider Name (Legal Business Name): RUBY NIEVES DELAMATA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUBY NIEVES MATA M.D.

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 J D ANDERSON DR
MORGANTOWN WV
26505-3494
US

IV. Provider business mailing address

1200 J D ANDERSON DR
MORGANTOWN WV
26505-3494
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-1560
  • Fax: 304-598-1699
Mailing address:
  • Phone: 304-598-1560
  • Fax: 304-598-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number10994
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: