Provider Demographics
NPI:1609061399
Name:THEODORE P WERBLIN MD PC
Entity Type:Organization
Organization Name:THEODORE P WERBLIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WERBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-6123
Mailing Address - Street 1:1051 STAFFORD DR
Mailing Address - Street 2:PO BOX 5879
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2409
Mailing Address - Country:US
Mailing Address - Phone:304-487-6123
Mailing Address - Fax:304-425-2631
Practice Address - Street 1:1051 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2409
Practice Address - Country:US
Practice Address - Phone:304-487-6123
Practice Address - Fax:304-425-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12870207W00000X
261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096798000Medicaid
WV0096798000Medicaid
WV9201772Medicare PIN
VAC09347Medicare PIN