OrganizationActive
Braddock Medical Group P.A.
NPI 1104962729 · Adult Medicine Physician · Fort Ashby, WV
Provider details
- NPI number
- 1104962729
- Entity type
- Organization
- Primary specialty
- Adult Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Braddock Medical Group PA
- Organization subpart
- Yes
- Authorized official
- Paul Livengood, Owner(304) 298-3605
- License
- 11172 (WV)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
70 Presidents Street
Unit 1150
Fort Ashby, WV 26719-1150
Phone: (304) 298-3605
Fax: (304) 298-3578
Approximate (ZIP-level) locationGet directions
Mailing address
70 Presidents Street
Fort Ashby, WV 26719-1150
Other names (DBA / former)
- Other name
- Fort Ashby Family Practice
Registry dates
- Enumerated
- 2007-01-30
- Last updated
- 2016-11-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.