Healthcare Provider Details

I. General information

NPI: 1447295795
Provider Name (Legal Business Name): LISA ANNE MCBRIDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANNE WOOD M.D.

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 COOMBS FARM RD STE 102
MORGANTOWN WV
26508-1150
US

IV. Provider business mailing address

1247 SUNCREST TOWNE CENTRE
MORGANTOWN WV
26505
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-8000
  • Fax: 304-599-8003
Mailing address:
  • Phone: 304-599-8000
  • Fax: 304-599-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22287
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: