Provider Demographics
NPI:1124010459
Name:HADRYCH, JERRY I (DPM)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:I
Last Name:HADRYCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2266
Mailing Address - Country:US
Mailing Address - Phone:304-599-3338
Mailing Address - Fax:304-599-2623
Practice Address - Street 1:3280 UNIVERSITY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2266
Practice Address - Country:US
Practice Address - Phone:304-599-3338
Practice Address - Fax:304-599-2623
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV320213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01623405Medicaid
WVWV00320OtherSTATE
WV0099983000Medicaid
WVWV00320OtherSTATE
U60743Medicare UPIN
WV0099983000Medicaid