Provider Demographics
NPI:1043536899
Name:MORRIS, SAMUEL RYAN (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RYAN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARCLEY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2977
Mailing Address - Country:US
Mailing Address - Phone:304-263-8911
Mailing Address - Fax:304-263-9450
Practice Address - Street 1:101 MARCLEY DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2977
Practice Address - Country:US
Practice Address - Phone:304-263-8911
Practice Address - Fax:304-263-9450
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV3394AMedicare PIN