1316946973 NPI number — DR. BRIDGET D. MAGNETTI PHD

Table of content: DR. BRIDGET D. MAGNETTI PHD (NPI 1316946973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316946973 NPI number — DR. BRIDGET D. MAGNETTI PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGNETTI
Provider First Name:
BRIDGET
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRIS
Provider Other First Name:
BRIDGET
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316946973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-263-4999
Provider Business Mailing Address Fax Number:
304-264-0508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 TAVERN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-263-7023
Provider Business Practice Location Address Fax Number:
304-264-0508
Provider Enumeration Date:
07/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP1600X , with the licence number:  885 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 885 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810001317 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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