Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 23661 | WV |
NPI | 1003013582 |
---|---|
Provider Name | Dr. Treah Shea Haggerty |
First Address | Morgantown, WV 26507-0897 |
Second Address | Morgantown, WV 26501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 06/01/2021 |