Healthcare Provider Details

I. General information

NPI: 1942276860
Provider Name (Legal Business Name): MICHELLE COLEV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROUTE 98 W ST SUITE 304
NUTTER FORT WV
26301-4385
US

IV. Provider business mailing address

PO BOX 4355
MORGANTOWN WV
26504-4355
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-5880
  • Fax: 304-622-5882
Mailing address:
  • Phone: 304-685-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number21845
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD428960
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: