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Individual

DR. MATTHEW D BRUNNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M. D.

Contact information

Practice address
1 STADIUM DRIVE, MORGANTOWN, WV 26506
(304) 598-4800
(304) 598-4871
Mailing address
P. O. BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-7401
(304) 293-6963

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20180
WV
208000000X
Pediatrics Physician
20180
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0018054170001
PA
05
1807520000
WV
05
2224506
OH
05
6737951
VA
05
744441900
MD
Enumeration date
08/16/2006
Last updated
10/22/2010
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