Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 23065 | WV |
N | 208000000X | Pediatrician | MD057257L | PA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 23065 | WV |
N | 2080P0207X | Pediatric Hematology-Oncologist | MD057257L | PA |
NPI | 1194713008 |
---|---|
Provider Name | Stephen Paul |
First Address | Morgantown, WV 26506-1200 |
Second Address | Morgantown, WV 26506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015493170004 | (05) | PA |