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General NPI Number Information
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NPI Number | 1881021533
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Entity Type | Organization
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Legal Business Name | SUNCREST OBSTETRICS AND GYNECOLOGY
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 1272 SUNCREST TOWN CENTRE DR
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City | MORGANTOWN
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State | WV
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Zip | 26505-1828
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Country | US
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Telephone | 304-212-5423
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Fax |
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Provider Business Mailing Address
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Address Line | 1272 SUNCREST TOWN CENTRE DR
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City | MORGANTOWN
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State | WV
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Zip | 26505-1828
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Country | US
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Telephone | 304-212-5423
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KERRI G HALL
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Credential | M.D.
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Telephone | 304-212-5423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 22610
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License Number State | WV
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