MEDICARE: DR. MARY E CONTI M.D.

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	174400000X	Specialist	036050872	IL
2	174400000X	Specialist	R5635	MO
3	2085R0001X	Radiation Oncology Physician	24166	WV
4	174400000X	Specialist	24166	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00128699	OTHER	IL	RAILROAD MEDICARE
4	920001176	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27934	OTHER	IL	BLUE CROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	203804	OTHER	MO	BLUE CROSS/BLUE SHIELD
6	27935	OTHER	MO	BLUE CHOICE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255303558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E CONTI M.D.

Provider Business Mailing Address
First Line	:	1400 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-4114
Country	:	US
Telephone Number	:	304-399-6501
Fax Number	:	304-399-6528

Provider Business Practice Location Address
First Line	:	1400 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-4114
Country	:	US
Telephone Number	:	304-399-6501
Fax Number	:	304-399-6528

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	11/24/2010

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