Healthcare Provider Details

I. General information

NPI: 1427576248
Provider Name (Legal Business Name): SEAN MICHAEL COFFEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MON HEALTH MEDICAL PARK DR STE 1103
MORGANTOWN WV
26505-1143
US

IV. Provider business mailing address

1200 J D ANDERSON DR
MORGANTOWN WV
26505-3494
US

V. Phone/Fax

Practice location:
  • Phone: 304-285-2835
  • Fax:
Mailing address:
  • Phone: 304-598-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2968
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059501
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA059501
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.005832RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: