Provider Demographics
NPI:1245200989
Name:MORGANTOWN PULMONARY ASSOCIATES PC
Entity type:Organization
Organization Name:MORGANTOWN PULMONARY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABRAHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-2336
Mailing Address - Street 1:1265 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2713
Mailing Address - Country:US
Mailing Address - Phone:304-598-2336
Mailing Address - Fax:304-598-3717
Practice Address - Street 1:1265 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2713
Practice Address - Country:US
Practice Address - Phone:304-598-2336
Practice Address - Fax:304-598-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCM6724OtherRAILROAD MEDICARE
WV0008466000Medicaid
WV0008466000Medicaid