Provider Demographics
NPI:1174549620
Name:THEODORE P. WERBLIN MD, PC.
Entity type:Organization
Organization Name:THEODORE P. WERBLIN MD, PC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WERBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-6123
Mailing Address - Street 1:PO BOX 5879
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-5879
Mailing Address - Country:US
Mailing Address - Phone:304-487-6123
Mailing Address - Fax:304-425-2631
Practice Address - Street 1:1051 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2409
Practice Address - Country:US
Practice Address - Phone:304-487-6123
Practice Address - Fax:304-425-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096798001Medicaid
WVA72853Medicare UPIN
WV0096798001Medicaid