Provider Demographics
NPI:1548446099
Name:MORGANTOWN PLASTIC SURGERY ASSOCIATES
Entity type:Organization
Organization Name:MORGANTOWN PLASTIC SURGERY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-777-4677
Mailing Address - Street 1:5000 COOMBS FARM DR
Mailing Address - Street 2:STE 102
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1121
Mailing Address - Country:US
Mailing Address - Phone:304-777-4677
Mailing Address - Fax:304-777-4679
Practice Address - Street 1:5000 COOMBS FARM DR
Practice Address - Street 2:STE 102
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1121
Practice Address - Country:US
Practice Address - Phone:304-777-4677
Practice Address - Fax:304-777-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21436208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty