Provider Demographics
NPI:1376588079
Name:BARCLAY, ROGER STEVENSON (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:STEVENSON
Last Name:BARCLAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:200 WEDGEWOOD DR
Mailing Address - Street 2:STE 102
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-599-0563
Mailing Address - Fax:304-599-0564
Practice Address - Street 1:200 WEDGEWOOD DR
Practice Address - Street 2:STE 102
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-0563
Practice Address - Fax:304-599-0564
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0071335000Medicaid
A72424Medicare UPIN
WV0071335000Medicaid