Healthcare Provider Details

I. General information

NPI: 1336056654
Provider Name (Legal Business Name): LOGAN ANDREW KNOPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MEDICAL CENTER DR
MORGANTOWN WV
26505-3409
US

IV. Provider business mailing address

1331 RIDDLE AVE
MORGANTOWN WV
26505-2631
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-1386
  • Fax:
Mailing address:
  • Phone: 304-807-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: