MEDICARE: MR. KELLY MCCOY PITSENBARGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	WV13927	WV

General Provider Information

NPI Number	:	1023004744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KELLY MCCOY PITSENBARGER MD

Provider Business Mailing Address
First Line	:	PO BOX 1437
Second Line	:
City	:	SHADY SPRING
State	:	WV
Zip	:	25918-1437
Country	:	US
Telephone Number	:	304-255-2426
Fax Number	:	304-253-3715

Provider Business Practice Location Address
First Line	:	126 CARPENTER ST
Second Line	:
City	:	SHADY SPRING
State	:	WV
Zip	:	25918-8417
Country	:	US
Telephone Number	:	304-255-2426
Fax Number	:	304-253-3715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	10/23/2024

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