Organization
MORGANTOWN UROLOGIC ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WILDA LEE MARSTILLER (OFFICE MANAGER)
(304) 598-2906
Entity
Organization
Contact information
Practice address
1000 J D ANDERSON DR, SUITE 401, MORGANTOWN, WV 26505-1238
(304) 598-2906
(304) 599-1802
Mailing address
1000 J D ANDERSON DR, SUITE 401, MORGANTOWN, WV 26505-1238
(304) 598-2906
(304) 599-1802
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
001
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007813000
—
WV
01
—
001709698
BLUE CROSS BLUE SHIELD
WV
01
—
0851442
UMWA
WV
Enumeration date
08/07/2006
Last updated
07/21/2022
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