Provider Demographics
NPI:1720472749
Name:STILGER, VINCENT GERARD (HSD, ATC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:GERARD
Last Name:STILGER
Suffix:
Gender:M
Credentials:HSD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 S PIERPONT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4147
Mailing Address - Country:US
Mailing Address - Phone:304-594-0237
Mailing Address - Fax:304-293-4641
Practice Address - Street 1:375 BIRCH ST
Practice Address - Street 2:WEST VIRGINIA UNIVERSITY
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3418
Practice Address - Country:US
Practice Address - Phone:304-293-0872
Practice Address - Fax:304-293-4641
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0010312083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine