Healthcare Provider Details

I. General information

NPI: 1093385353
Provider Name (Legal Business Name): CORISSA NICOLE MCDONALD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 CHEAT RD
MORGANTOWN WV
26508-4210
US

IV. Provider business mailing address

123 PINE LANE
MORGANTOWN WV
26508
US

V. Phone/Fax

Practice location:
  • Phone: 855-988-2273
  • Fax: 304-594-2408
Mailing address:
  • Phone: 810-824-8066
  • Fax: 304-243-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34126
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: