Organization · Type 2 NPI

Braddock Medical Group P.a.

Adult Medicine Physician · Fort Ashby, WV

NPI number 1104962729 Active

Practice location

70 Presidents Street, Unit 1150
Fort Ashby, WV 26719-1150

Call (304) 298-3605 Map

Fax (304) 298-3578

Specialties and licenses

TaxonomyCodeLicense
Adult Medicine Physician Primary 207QA0505X11172 (WV)

Adult Medicine Physician: The NUCC recommends this code not be used. Choose a more appropriate code.

About NPI 1104962729

Braddock Medical Group P.a.'s National Provider Identifier is 1104962729, issued on Jan 30, 2007. The primary taxonomy on file is Adult Medicine Physician (207QA0505X), and the practice location is in Fort Ashby, WV. The record was last updated on Nov 1, 2016.