Provider Demographics
NPI:1669683512
Name:WVU MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WVU MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:DESANTOS
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-617-7630
Mailing Address - Street 1:1228 VAN VOORHIS RD
Mailing Address - Street 2:F-4
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3469
Mailing Address - Country:US
Mailing Address - Phone:304-617-7630
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3469
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital