Provider Demographics
NPI:1558360610
Name:STUCHELL, BRYAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:STUCHELL
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 1:63 WHARF ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-5937
Mailing Address - Country:US
Mailing Address - Phone:304-291-3627
Mailing Address - Fax:304-598-3630
Practice Address - Street 1:63 WHARF ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-5937
Practice Address - Country:US
Practice Address - Phone:304-291-3627
Practice Address - Fax:304-598-3630
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV19964207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5600374000Medicaid
WVWV19964BOtherHEALTH PLAN
WV550783964004OtherMT STATE BCBS
H08099Medicare UPIN
WVWV19964BOtherHEALTH PLAN