Healthcare Provider Details

I. General information

NPI: 1013991355
Provider Name (Legal Business Name): MICHELE M MAOUAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWN CENTRE DR STE 115
MORGANTOWN WV
26505-1873
US

IV. Provider business mailing address

600 SUNCREST TOWN CENTRE DR STE 115
MORGANTOWN WV
26505-1873
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-3888
  • Fax: 304-598-0564
Mailing address:
  • Phone: 304-598-3888
  • Fax: 304-598-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number21247
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: