Healthcare Provider Details

I. General information

NPI: 1659329761
Provider Name (Legal Business Name): MELISSA DAWN KITZMILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422S MAIN ST
MOOREFIELD WV
26836-1238
US

IV. Provider business mailing address

22347 NORTHWESTERN PIKE
ROMNEY WV
26757-6343
US

V. Phone/Fax

Practice location:
  • Phone: 304-538-2331
  • Fax: 304-538-2663
Mailing address:
  • Phone: 304-822-3838
  • Fax: 304-822-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20333
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20333
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: