Organization
MD2U WEST VIRGINIA LLC
Active
Parent organization
MD2U MANAGEMENT LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MD2U MANAGEMENT LLC
Authorized official
GREGORY DAVID LATTA (CIO)
(502) 416-1851
Entity
Organization
Contact information
Practice address
3501 MACCORKLE AVE SE # 151, CHARLESTON, WV 25304-1419
(502) 327-9100
(855) 632-8329
Mailing address
140 WHITTINGTON PKWY STE 100, LOUISVILLE, KY 40222-4930
(502) 327-9100
(855) 632-8329
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/04/2013
Last updated
04/04/2013
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