Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 21247 | WV |
NPI | 1013991355 |
---|---|
Provider Name | Dr. Michele M Maouad |
First Address | Morgantown, WV 26505-1873 |
Second Address | Morgantown, WV 26505-1873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 11/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001751643 | BCBS (01) | WV |
3810002533 | (05) | WV |
7061507 | AETNA (01) | WV |
H87786 | (02) | |
WV21249A | HEALTH PLAN (01) | WV |