Individual
MARK FORREST LISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER DRIVE, ROOM 1144, MORGANTOWN, WV 26506
(304) 293-2463
(304) 293-5160
Mailing address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506-1200
(304) 598-4800
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25929
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2012
Last updated
04/15/2022
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