Provider Demographics
NPI:1205833258
Name:RAYBUCK, BRYAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:RAYBUCK
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-1200
Mailing Address - Country:US
Mailing Address - Phone:304-598-4800
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-598-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043192207RC0000X
WV27250207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
541042964OtherONE HEALTH PLAN/GREAT WST
VA006042031Medicaid
541042964OtherHEALTHNET/TRICARE/CHAMPUS
060007366OtherMEDICARE - RAILROAD
541042964OtherUNITED HEALTHCARE
4137746OtherAETNA PPO
6975-0007OtherCAREFIRST BCBS
502860OtherNCPPO
541042964OtherPHCS
054847OtherANTHEM BCBS/TRIGON
486305OtherAETNA HMO
541042964OtherCIGNO PPO
541042964OtherKAISER
541042964OtherHEALTHNET/TRICARE/CHAMPUS
VA006042031Medicaid