Provider Demographics
NPI:1194855676
Name:WARD PAINE, MD, PLLC
Entity type:Organization
Organization Name:WARD PAINE, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-777-4044
Mailing Address - Street 1:1526 MILEGROUND RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3745
Mailing Address - Country:US
Mailing Address - Phone:304-777-4044
Mailing Address - Fax:304-777-4046
Practice Address - Street 1:1526 MILEGROUND RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3745
Practice Address - Country:US
Practice Address - Phone:304-777-4044
Practice Address - Fax:304-777-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9367431Medicare PIN