MEDICARE: MRS. MARY C POZEGA D.O.

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	208000000X	Pediatrics Physician	1512	WV

General Provider Information

NPI Number	:	1124072905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY C POZEGA D.O.

Provider Business Mailing Address
First Line	:	6637 KANAWHA AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2915
Country	:	US
Telephone Number	:	304-926-6637
Fax Number	:

Provider Business Practice Location Address
First Line	:	5324 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2222
Country	:	US
Telephone Number	:	304-925-7001
Fax Number	:	304-925-7234

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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