Basic Information
Provider Information
NPI: 1033102561
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEIGHEN
FirstName: BENJAMIN
MiddleName: J
NamePrefix: MR.
NameSuffix:  
Credential: PAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MEDICAL CENTER DR
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 265061200
CountryCode: US
TelephoneNumber: 3045984800
FaxNumber:  
Practice Location
Address1: 575 COAL VALLEY RD STE 504
Address2:  
City: CLAIRTON
State: PA
PostalCode: 150253729
CountryCode: US
TelephoneNumber: 4122676810
FaxNumber: 4122676817
Other Information
ProviderEnumerationDate: 08/30/2005
LastUpdateDate: 10/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA051132PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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