Healthcare Provider Details

I. General information

NPI: 1720102080
Provider Name (Legal Business Name): CHRISTINA DAGUE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/30/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 PENNSYLVANIA AVE STE 3
WEIRTON WV
26062-3770
US

IV. Provider business mailing address

3045 PENNSYLVANIA AVE STE 3
WEIRTON WV
26062-3770
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-4000
  • Fax: 304-723-4003
Mailing address:
  • Phone: 304-723-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00971
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: