institution
Braddock Medical Group P.a.
Adult Medicine Physician in Fort Ashby, West Virginia
NPI 1104962729

Braddock Medical Group P.a. is an Adult Medicine Physician based in Fort Ashby, WV and is specialized in Adult Medicine. Braddock Medical Group P.a. practices in Fort Ashby, WV. The NPI Number for Braddock Medical Group P.a. is 1104962729 and holds a License No. 11172 (West Virginia).

The current practice location address for Braddock Medical Group P.a. is 70 Presidents Street, Fort Ashby, WV and can be reached out via phone at 304-298-3605 and via fax at 304-298-3578.

Location: 70 Presidents Street, Fort Ashby, WV, 26719-1150
institution
Provider Profile Details
NPI Number
1104962729
Provider Name
Braddock Medical Group P.a.
Credential
Provider Entity Type
Organization
Address
70 Presidents Street, Fort Ashby, WV, 26719-1150
Phone Number
304-298-3605
Fax Number
304-298-3578
Provider Enumeration Date
01/30/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
850-290 01 MAMSI MDIPA OPTIMUM
H529BR 01 MD BCBS GROUP #
W399 01 BCBS FEDERAL PROVIDER #
00716943 01 WV BCBS PROVIDER #
41707101 01 MD BCBS PROVIDER #
3810000010 05 WV
0003 01 BCBS FEDERAL GROUP #
0056043000 05 WV
institution
Provider Business Practice Location Address Details
Address
70 Presidents Street
City
State
Zip
26719-1150
Phone Number
304-298-3605
Fax Number
304-298-3578
person
Provider Business Mailing Address Details
Address
70 Presidents Street
City
State
Zip
26719-1150
Phone Number
304-298-3605
Fax Number
304-298-3578
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
Adult Medicine
Taxonomy
License No.
11172 (West Virginia)
Definition
Definition to come.
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