Healthcare Provider Details

I. General information

NPI: 1730355686
Provider Name (Legal Business Name): EMILY SUSAN CLAGG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208-7713
US

IV. Provider business mailing address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208-7713
US

V. Phone/Fax

Practice location:
  • Phone: 304-226-5725
  • Fax: 304-226-3274
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2318
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: