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1013993047

NPI Code Detail

MEDICARE: DEBORAH THOREN MOWERY MD

MEDICARE: DEBORAH THOREN MOWERY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	29759	WV
2	208100000X	Physical Medicine & Rehabilitation Physician	0101045890	VA
3	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	0101045890	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	216786	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	250012231	OTHER		MC RAILROAD

General Provider Information

NPI Number	:	1013993047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH THOREN MOWERY MD

Provider Business Mailing Address
First Line	:	44 KINGSTON DR # 193
Second Line	:
City	:	DALEVILLE
State	:	VA
Zip	:	24083-2574
Country	:	US
Telephone Number	:	304-554-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 VAN VOORHIS RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-3437
Country	:	US
Telephone Number	:	304-554-9494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	09/24/2021

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Directions to “ DEBORAH THOREN MOWERY MD” Practice Location

Language	Start Address	Practice Location

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