Healthcare Provider Details

I. General information

NPI: 1699383158
Provider Name (Legal Business Name): EMILY JOYCE VIGLIANCO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY JOYCE COURTWRIGHT

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

2207 UNIVERSITY COMMONS DR
MORGANTOWN WV
26505-0212
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4000
  • Fax:
Mailing address:
  • Phone: 724-833-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2384
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: