Healthcare Provider Details

I. General information

NPI: 1255303558
Provider Name (Legal Business Name): MARY E CONTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

IV. Provider business mailing address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-6501
  • Fax: 304-399-6528
Mailing address:
  • Phone: 304-399-6501
  • Fax: 304-399-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036050872
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR5635
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number24166
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24166
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: