Individual
PHONPHANH DEDTHANOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1 MEDICAL CENTER DR, 1310 HSC, MORGANTOWN, WV 26506
(304) 293-2342
(304) 293-7725
Mailing address
130 RED MULBERRY WAY APT 2, CHARLESTON, WV 25306-6317
(515) 779-4571
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/20/2022
Last updated
03/20/2022
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