Provider Demographics
NPI:1578529772
Name:BARRETA, TELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TELLY
Middle Name:M
Last Name:BARRETA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:PATHOLOGY DEPT
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-5550
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVENUE SE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5550
Practice Address - Fax:304-388-4352
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-11-23
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Provider Licenses
StateLicense IDTaxonomies
WV17752207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA7208581Medicare PIN
BA4279331Medicare PIN
WVF32611Medicare UPIN
P008356661Medicare PIN