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General NPI Number Information
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NPI Number | 1447295795
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Entity Type | Individual
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Provider Name | LISA ANNE MCBRIDE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 9000 COOMBS FARM RD STE 102
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City | MORGANTOWN
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State | WV
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Zip | 26508-1150
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Country | US
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Telephone | 304-599-8000
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Fax | 304-599-8003
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Provider Business Mailing Address
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Address Line | 1247 SUNCREST TOWNE CENTRE
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City | MORGANTOWN
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State | WV
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Zip | 26505
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Country | US
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Telephone | 304-599-8000
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Fax | 304-599-8003
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 22287
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License Number State | WV
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