Healthcare Provider Details

I. General information

NPI: 1467446526
Provider Name (Legal Business Name): MARY E MCKELVEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 AIRPORT RD
BEAVER WV
25813-9421
US

IV. Provider business mailing address

200 POCAHONTAS TRL P.O BOX 457
WHITE SULPHUR SPRINGS WV
24986-5026
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-5155
  • Fax: 304-252-3471
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15767
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: