Basic Information
Provider Information
NPI: 1003013582
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAGGERTY
FirstName: TREAH
MiddleName: SHEA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 897
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 265070897
CountryCode: US
TelephoneNumber: 3042937401
FaxNumber: 3042936963
Practice Location
Address1: 1 MEDICAL CENTER DRIVE
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 26501
CountryCode: US
TelephoneNumber: 3042937401
FaxNumber: 3042936963
Other Information
ProviderEnumerationDate: 06/28/2007
LastUpdateDate: 10/13/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X23661WVY Allopathic & Osteopathic PhysiciansFamily Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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