Provider Demographics
NPI:1700134699
Name:ROGER S. BARCLAY M.D.
Entity type:Organization
Organization Name:ROGER S. BARCLAY M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:STEVENSON
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-599-0563
Mailing Address - Street 1:200 WEDGEWOOD DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2442
Mailing Address - Country:US
Mailing Address - Phone:304-599-0563
Mailing Address - Fax:304-599-0564
Practice Address - Street 1:200 WEDGEWOOD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2442
Practice Address - Country:US
Practice Address - Phone:304-599-0563
Practice Address - Fax:304-599-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV007133500Medicaid
WVBA0525132OtherMEDICARE UNSPECIFIED
WV007133500Medicaid