Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 21788 | WV |
NPI | 1033310719 |
---|---|
Provider Name | Susanne Choby |
First Address | Morgantown, WV 26504-4650 |
Second Address | Morgantown, WV 26505-1872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810010885 | (05) | WV |