Organization
CLARKSBURG ENT - UHA
Active
Parent organization
WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Authorized official
ROBYN M MCDANIEL (PROVIDER RELATIONS SUPERVISOR)
(304) 293-5033
Entity
Organization
Contact information
Practice address
700 GENESIS BLVD, BRIDGEPORT, WV 26330-9668
(304) 598-4825
Mailing address
PO BOX 780, MORGANTOWN, WV 26507-0780
(304) 293-7401
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011526000
—
WV
Enumeration date
07/14/2009
Last updated
07/14/2009
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