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NPI 1104937416

OrganizationActive

Pediatric Associate

NPI 1104937416 · Legal Medicine · Bridgeport, WV

Provider details

NPI number: 1104937416
Entity type: Organization
Primary specialty: Legal MedicineOther Service Providers
Authorized official: Joseph Momen, Owner
License: WV11941 (WV)

Practice location

11 Chenoweth Dr

Suite a

Bridgeport, WV 26330-1675

Phone: (304) 842-5777

Fax: (304) 842-3318

More WV providers

Mailing address

11 Chenoweth Dr

Bridgeport, WV 26330-1675

Registry dates

Enumerated: 2006-08-31
Last updated: 2020-08-22

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Pediatric Associate — NPI 1104937416, Bridgeport, WV | NPI Central