Provider Demographics
NPI:1972894301
Name:STATLER, KRISTEN D (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:STATLER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1103
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1143
Mailing Address - Country:US
Mailing Address - Phone:304-599-1448
Mailing Address - Fax:304-599-5335
Practice Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1103
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-1448
Practice Address - Fax:304-599-5335
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2021-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV26830208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV6807C185Medicare UPIN