# OLD MILL INTERNISTS, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821123159
- **Authorized official:** MRS. KITTY R MISIEWICZ (OFFICE MANAGER)
- **Authorized official phone:** (304) 263-7591

## Contact information

- **Practice address:** 2008 PROFESSIONAL COURT, MARTINSBURG, WV 25401
- **Practice address phone:** (304) 263-7591
- **Practice address fax:** (304) 263-8318
- **Mailing address:** PO BOX 948, MARTINSBURG, WV 25402-0948
- **Mailing address fax:** (304) 263-8318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RH0003X | Hematology & Oncology Physician | 11538 | WV | Yes |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0008767001 | — | WV |
| 05 | — | 0082852000 | — | WV |