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General NPI Number Information
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NPI Number | 1548446099
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Entity Type | Organization
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Legal Business Name | MORGANTOWN PLASTIC SURGERY ASSOCIATES
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 5000 COOMBS FARM DR STE 102
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City | MORGANTOWN
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State | WV
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Zip | 26508-1121
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Country | US
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Telephone | 304-777-4677
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Fax | 304-777-4679
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Provider Business Mailing Address
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Address Line | 5000 COOMBS FARM DR STE 102
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City | MORGANTOWN
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State | WV
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Zip | 26508-1121
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Country | US
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Telephone | 304-777-4677
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Fax | 304-777-4679
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | BECKY A MILLER
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Credential |
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Telephone | 304-777-4677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 21436
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License Number State | WV
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