Provider Demographics
NPI:1336287614
Name:PRINCETON INTERNISTS INC
Entity Type:Organization
Organization Name:PRINCETON INTERNISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-1431
Mailing Address - Street 1:100 NEW HOPE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2143
Mailing Address - Country:US
Mailing Address - Phone:304-487-1431
Mailing Address - Fax:304-425-5813
Practice Address - Street 1:100 NEW HOPE RD STE 7
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2143
Practice Address - Country:US
Practice Address - Phone:304-487-1431
Practice Address - Fax:304-425-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV=========OtherTAX ID NUMBER
WV9163431Medicare ID - Type Unspecified