Organization
UHA PED-ADOLES GRP PRACT (PAASGRP)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY D MILLER (PROVIDER RELATIONS ANALSYT)
(304) 293-5033
Entity
Organization
Contact information
Practice address
1 STADIUM DRIVE, MORGANTOWN, WV 26506
(304) 293-5033
(304) 293-6963
Mailing address
PO BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-5033
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
0007384008
WV
Other
Enumeration date
05/11/2007
Last updated
08/22/2020
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