Basic Information
| Provider Information | |||||||||
| NPI: | 1578529772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRETA | ||||||||
| FirstName: | TELLY | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 MACCORKLE AVE SE | ||||||||
| Address2: | PATHOLOGY DEPT | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 MACCORKLE AVENUE SE | ||||||||
| Address2: | PATHOLOGY DEPARTMENT | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885550 | ||||||||
| FaxNumber: | 3043884352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 11/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 17752 | WV | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 17752 | WV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.