Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 23011 | WV |
NPI | 1316138324 |
---|---|
Provider Name | Mary S Payne |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810012774 | (05) | WV |