=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295149672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BORIS GETMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2014
-----------------------------------------------------
Last Update Date | 08/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MEDICAL CENTER DRIVE ROOM 4601
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-293-7542
-----------------------------------------------------
Fax | 304-293-5709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5213 S ALSTON AVE
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-4430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-620-4855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2021-02131
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 39020000
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------