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General NPI Number Information
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NPI Number | 1821123159
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Entity Type | Organization
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Legal Business Name | OLD MILL INTERNISTS, LTD
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2008 PROFESSIONAL COURT
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City | MARTINSBURG
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State | WV
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Zip | 25401
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Country | US
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Telephone | 304-263-7591
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Fax | 304-263-8318
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Provider Business Mailing Address
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Address Line | PO BOX 948
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City | MARTINSBURG
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State | WV
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Zip | 25402-0948
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Country | US
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Telephone |
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Fax | 304-263-8318
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KITTY R MISIEWICZ
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Credential |
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Telephone | 304-263-7591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 11538
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License Number State | WV
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