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General NPI Number Information
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NPI Number | 1780552786
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Entity Type | Organization
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Legal Business Name | WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 61 CAMPUS DR STE 300
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City | MARTINSBURG
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State | WV
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Zip | 25404-7542
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Country | US
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Telephone | 304-596-5160
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 780
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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 |
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Fax |
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | JUSTIN GIBSON
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Credential |
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Telephone | 304-598-4256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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