Individual provider Active NPI

Marylou Hingco Petredis, NP

  • Family Nurse Practitioner
  • Martinsburg, WV
National Provider Identifier
1346110335
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
124432 Issued in WV
Practice address
2500 Hospital Dr
Martinsburg, WV 25401-3402
Phone
(304) 264-1000
NPI assigned
Nov 6, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 124432 WV Primary

Addresses

Primary practice location

2500 Hospital Dr
Martinsburg, WV 25401-3402

Mailing address

2500 Hospital Dr
Martinsburg, WV 25401-3402
Phone (304) 264-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260205000104 WV Practitioner - Nurse Practitioner 7012496508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

65 Health Care LN
Martinsburg, WV 25401-4006

PO Box
Suite 780
Morgantown, WV 26507-0780

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
124432WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince Jan 21, 2026 Accepting new patients
West Virginia University Medical Corporation CurrentSince Jan 21, 2026 Accepting new patients

Locations

2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1346110335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 HOSPITAL DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254013402",
            "telephone_number": "304-264-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 HOSPITAL DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254013402",
            "telephone_number": "304-264-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETREDIS",
        "first_name": "MARYLOU",
        "middle_name": "HINGCO",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-11-06",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "124432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

Verify at the official NPI Registry.