Provider Demographics
NPI:1124135140
Name:MARSTELLER, AMY ALBRECHT (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ALBRECHT
Last Name:MARSTELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:ALBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:85 DONOHOE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-8887
Practice Address - Country:US
Practice Address - Phone:304-399-3310
Practice Address - Fax:304-523-5416
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006609Medicaid
OH2685689Medicaid
KY7100012500Medicaid
WV3810006609Medicaid
WVWV2536AMedicare PIN
OH2685689Medicaid
WV4191331Medicare Oscar/Certification
WVWV2536C197Medicare PIN
WVI60036Medicare UPIN