Healthcare Provider Details

I. General information

NPI: 1407843832
Provider Name (Legal Business Name): MICHELLE LYNN FOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN HESS MD

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WHEELING AVE
GLEN DALE WV
26038-1536
US

IV. Provider business mailing address

PO BOX 763
MORGANTOWN WV
26507-0763
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-1500
  • Fax:
Mailing address:
  • Phone: 800-541-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20824
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: