| NPI | 1982720801 |
|---|---|
| Other Name | MSMR |
| Entity Type | Organization |
| Authorized Contact | DOSHIA K PETRY WARD Practice Manager 304-400-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WV 1767) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 1818) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2022-01-31 |