Organization
FAIRMONT MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY L VANDERGRIFT (PRESIDENT)
(304) 366-0700
Entity
Organization
Contact information
Practice address
1322 LOCUST AVE, FAIRMONT, WV 26554
(304) 366-0700
(304) 366-9529
Mailing address
1322 LOCUST AVE, PO BOX 1112, FAIRMONT, WV 26554
(304) 366-0700
(304) 366-9529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0035167000
—
WV
Enumeration date
10/17/2006
Last updated
10/25/2012
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