Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 1013 | WV |
NPI | 1316436694 |
---|---|
Provider Name | Erona Reza |
First Address | Morgantown, WV 26501-2421 |
Second Address | Morgantown, WV 26501-2421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2018 |
Last Update Date | 10/01/2021 |