Healthcare Provider Details

I. General information

NPI: 1467411454
Provider Name (Legal Business Name): FREDERICK W AMMERMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PRESTON ST
RANSON WV
25438-1631
US

IV. Provider business mailing address

PO BOX 897
MORGANTOWN WV
26507-0897
US

V. Phone/Fax

Practice location:
  • Phone: 304-535-6343
  • Fax:
Mailing address:
  • Phone: 304-293-7401
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2012
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: