Provider Demographics
NPI:1245310762
Name:HUNTINGTON UROLOGICAL ASSOC LAB
Entity type:Organization
Organization Name:HUNTINGTON UROLOGICAL ASSOC LAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORABITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-525-3711
Mailing Address - Street 1:2860 3RD AVENUE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1453
Mailing Address - Country:US
Mailing Address - Phone:304-525-3711
Mailing Address - Fax:304-525-2748
Practice Address - Street 1:2860 3RD AVENUE
Practice Address - Street 2:SUITE 230
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1453
Practice Address - Country:US
Practice Address - Phone:304-525-3711
Practice Address - Fax:304-525-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0009178001Medicaid