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General NPI Number Information
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NPI Number | 1982720801
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATE MEDICINE AND RHEUMATOLOGY PLLC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1120 KANAWHA BLVD E STE 200
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City | CHARLESTON
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State | WV
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Zip | 25301-2400
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Country | US
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Telephone | 304-400-4900
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Fax | 304-400-4907
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Provider Business Mailing Address
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Address Line | 1120 KANAWHA BLVD E STE 200
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City | CHARLESTON
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State | WV
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Zip | 25301-2400
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Country | US
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Telephone | 304-400-4900
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Fax | 304-400-4907
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DOSHIA K PETRY WARD
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Credential | CMOM, CMC,CMPM, CMA
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Telephone | 304-400-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1818
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1767
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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