Provider Demographics
NPI:1598135386
Name:MOUNTAINEER PULMONOLOGY, PLLC
Entity Type:Organization
Organization Name:MOUNTAINEER PULMONOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MUDRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-636-6131
Mailing Address - Street 1:1200 HARRISON AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3392
Mailing Address - Country:US
Mailing Address - Phone:304-636-6131
Mailing Address - Fax:304-637-5203
Practice Address - Street 1:1200 HARRISON AVE STE 121
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3392
Practice Address - Country:US
Practice Address - Phone:304-636-6131
Practice Address - Fax:304-637-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty