Active NPI
Phonphanh Dedthanou, DO
- Neurology Physician
- Morgantown, WV
National Provider Identifier
1447909346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- MED-PHYS-LIC-173223
- Practice address
- 1 Medical Center Dr
1310 HSC
Morgantown, WV 26506 - Phone
- (304) 293-2342
- Fax
- (304) 293-7725
- NPI assigned
- Mar 20, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | MED-PHYS-LIC-173223 | MT | Primary |
Addresses
Primary practice location
1 Medical Center Dr
1310 HSC
Morgantown, WV 26506
Mailing address
130 Red Mulberry Way Apt 2
Charleston, WV 25306-6317
Phone (515) 779-4571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MED-PHYS-LIC-173223 | MT | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780531200000",
"number": "1447909346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 RED MULBERRY WAY APT 2",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253066317",
"telephone_number": "515-779-4571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER DR",
"address_2": "1310 HSC",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "26506",
"telephone_number": "304-293-2342",
"fax_number": "304-293-7725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDTHANOU",
"first_name": "PHONPHANH",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-20",
"last_updated": "2026-06-04",
"certification_date": "2026-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MT",
"license": "MED-PHYS-LIC-173223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morgantown, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.