Provider Demographics
NPI:1154392983
Name:WRIGHT, GARTH BRADFORD (MD)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:BRADFORD
Last Name:WRIGHT
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 1:912 SOMERSET BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3952
Mailing Address - Country:US
Mailing Address - Phone:304-725-2663
Mailing Address - Fax:304-724-0053
Practice Address - Street 1:912 SOMERSET BLVD
Practice Address - Street 2:STE 101
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-3952
Practice Address - Country:US
Practice Address - Phone:304-725-2663
Practice Address - Fax:304-724-0053
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031796207X00000X
WV26776207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3841787Medicaid
TNBO6667Medicare UPIN
TN200035173Medicare PIN
TN3841787Medicaid
TN1141740001Medicare NSC
TN3841787Medicare PIN