MEDICARE: KALIKA MILLER PITCHER PA-C

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	363A00000X	Physician Assistant	01869	WV

General Provider Information

NPI Number	:	1720485956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALIKA MILLER PITCHER PA-C

Provider Business Mailing Address
First Line	:	2500 FOUNDATION WAY
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-9000
Country	:	US
Telephone Number	:	304-264-9202
Fax Number	:	304-264-9042

Provider Business Practice Location Address
First Line	:	912 SOMERSET BLVD STE 102
Second Line	:
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-3952
Country	:	US
Telephone Number	:	304-725-2273
Fax Number	:	304-725-0053

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

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	04/06/2022

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