Organization
MOUNTAIN STATE VASCULAR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN ROLAND WHYTE MD (OWNER)
(304) 250-0382
Entity
Organization
Contact information
Practice address
121 GEORGE STREET, BECKLEY, WV 25801
(304) 250-0382
Mailing address
PO BOX 1267, LEWISBURG, WV 24901-4267
(304) 890-9910
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
22852
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1795
WV BOARD OF MEDICINE REGISTRATION
WV
01
—
9ALVR
STATE OF WV CERTIFICATE
WV
Enumeration date
05/31/2018
Last updated
05/22/2024
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