MEDICARE: MORGANTOWN UROLOGIC ASSOCIATES, INC

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	174400000X	Specialist	001	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001709698	OTHER	WV	BLUE CROSS BLUE SHIELD
2	0851442	OTHER	WV	UMWA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033128970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORGANTOWN UROLOGIC ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	1000 J D ANDERSON DR
Second Line	:	SUITE 401
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1238
Country	:	US
Telephone Number	:	304-598-2906
Fax Number	:	304-599-1802

Provider Business Practice Location Address
First Line	:	1000 J D ANDERSON DR
Second Line	:	SUITE 401
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1238
Country	:	US
Telephone Number	:	304-598-2906
Fax Number	:	304-599-1802

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. WILDA LEE MARSTILLER
Credential	:
Telephone Number	:	304-598-2906

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/21/2022

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