| NPI | 1073578803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON MARIE EBBERT Provider Application 304-234-8663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: WV 5) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WV 5) |
| 207R00000X Internal Medicine (Licence: WV 5) | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: WV 5) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 5) | |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: WV 5) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: WV 5) | |
| 207V00000X Obstetrics & Gynecology (Licence: WV 5) | |
| 207X00000X Orthopaedic Surgery (Licence: WV 5) | |
| 207ZC0500X Pathology, Cytopathology (Licence: WV 5) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WV 5) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WV 5) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 5) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WV 5) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2010-12-29 |