Healthcare Provider Details

I. General information

NPI: 1992782031
Provider Name (Legal Business Name): MARK DUFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DUNCAN RD
BUCKEYE WV
24924
US

IV. Provider business mailing address

150 DUNCAN RD
BUCKEYE WV
24924-9037
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-7400
  • Fax:
Mailing address:
  • Phone: 304-799-1090
  • Fax: 304-799-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03315
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1446
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1446
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1446
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: