Healthcare Provider Details

I. General information

NPI: 1700846953
Provider Name (Legal Business Name): ANDREW H MACE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STADIUM DR
MORGANTOWN WV
26506-7911
US

IV. Provider business mailing address

PO BOX 897
MORGANTOWN WV
26507-0897
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4000
  • Fax: 304-293-6963
Mailing address:
  • Phone: 304-293-7401
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number12312
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12312
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: