Provider Demographics
| NPI: | 1255189502 |
|---|---|
| Name: | WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION |
| Entity type: | Organization |
| Organization Name: | WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP, FINANCE |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JUSTIN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GIBSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 304-598-4256 |
| Mailing Address - Street 1: | PO BOX 780 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MORGANTOWN |
| Mailing Address - State: | WV |
| Mailing Address - Zip Code: | 26507-0780 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 304-285-7101 |
| Mailing Address - Fax: | 304-293-6963 |
| Practice Address - Street 1: | 251 N 4TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | OAKLAND |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21550-1375 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 301-533-4000 |
| Practice Address - Fax: | 304-895-8752 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2024-05-10 |
| Last Update Date: | 2025-03-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | Group - Multi-Specialty |
| No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | Group - Multi-Specialty |
| No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Multi-Specialty |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207ND0900X | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
