Provider Demographics
NPI:1912962325
Name:THRUSH, PETER KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:KENT
Last Name:THRUSH
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 1:1168 HALLECK RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-2370
Mailing Address - Country:US
Mailing Address - Phone:304-685-3603
Mailing Address - Fax:304-296-1945
Practice Address - Street 1:1168 HALLECK RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-2370
Practice Address - Country:US
Practice Address - Phone:304-685-3603
Practice Address - Fax:304-296-1945
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10115207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099093000Medicaid
WV0099093000Medicaid
0461911Medicare ID - Type Unspecified