Healthcare Provider Details

I. General information

NPI: 1821418765
Provider Name (Legal Business Name): DAVID GLENN HUSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BAKERS RIDGE RD
MORGANTOWN WV
26508-1500
US

IV. Provider business mailing address

201 BAKERS RIDGE RD
MORGANTOWN WV
26508-1500
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number29753
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: