Healthcare Provider Details

I. General information

NPI: 1982439659
Provider Name (Legal Business Name): MADISON ELIZABETH OBRAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 VAN VOORHIS RD STE 2
MORGANTOWN WV
26505-2737
US

IV. Provider business mailing address

432 1/2 DORSEY AVE
MORGANTOWN WV
26501-6420
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-8900
  • Fax:
Mailing address:
  • Phone: 304-943-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: