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General NPI Number Information
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NPI Number | 1003205402
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Entity Type | Organization
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Legal Business Name | MORGANTOWN OBSTETRIC AND GYNECOLOGY, PLLC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 1191 PINEVIEW DR STE H
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City | MORGANTOWN
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State | WV
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Zip | 26505-2778
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Country | US
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Telephone | 304-212-5620
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Fax | 304-241-4645
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Provider Business Mailing Address
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Address Line | 1191 PINEVIEW DR STE H
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City | MORGANTOWN
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State | WV
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Zip | 26505-2778
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Country | US
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Telephone | 304-212-5620
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Fax | 304-241-4645
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Authorized Official
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Title or Position | OWNER
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Name | MURSHID K ABDEL-LATIF
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Credential | M.D.
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Telephone | 304-212-5620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 50130
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 17237
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License Number State | WV
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