Provider Demographics
NPI:1710187356
Name:MILTENBERGER, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:MILTENBERGER
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 1:1000 MON HEALTH MEDICAL PARK DR STE 1202
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1143
Mailing Address - Country:US
Mailing Address - Phone:304-554-0111
Mailing Address - Fax:304-599-2705
Practice Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1202
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1143
Practice Address - Country:US
Practice Address - Phone:304-554-0111
Practice Address - Fax:304-599-2705
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV230602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry