Healthcare Provider Details

I. General information

NPI: 1316027410
Provider Name (Legal Business Name): HEATHER MARIE CLAWGES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 MAPLEWOOD AVE
RONCEVERTE WV
24970-8016
US

IV. Provider business mailing address

176 DAWKINS DR
LEWISBURG WV
24901-9302
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-6559
  • Fax: 304-793-2270
Mailing address:
  • Phone: 304-645-6083
  • Fax: 304-793-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21315
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: