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General NPI Number Information
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NPI Number | 1912962325
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Entity Type | Individual
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Provider Name | PETER KENT THRUSH MD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 1168 HALLECK RD
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City | MORGANTOWN
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State | WV
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Zip | 26508-2370
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Country | US
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Telephone | 304-685-3603
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Fax | 304-296-1945
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Provider Business Mailing Address
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Address Line | 1168 HALLECK RD
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City | MORGANTOWN
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State | WV
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Zip | 26508-2370
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Country | US
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Telephone | 304-685-3603
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Fax | 304-296-1945
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 10115
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License Number State | WV
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