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General NPI Number Information
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NPI Number | 1346506524
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Entity Type | Individual
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Provider Name | JUSTINE A PAGENHARDT MD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 800 WHEELING AVE
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City | GLEN DALE
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State | WV
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Zip | 26038-1660
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Country | US
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Telephone | 304-843-3313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 780 WEST VIRGINIA UNIVERSITY HOSPITALS
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City | MORGANTOWN
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State | WV
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Zip | 26507-0780
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Country | US
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Telephone | 304-285-7101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25613
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License Number State | WV
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