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General NPI Number Information
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NPI Number | 1093385353
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Entity Type | Individual
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Provider Name | CORISSA NICOLE MCDONALD M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 608 CHEAT RD
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City | MORGANTOWN
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State | WV
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Zip | 26508-4210
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Country | US
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Telephone | 855-988-2273
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Fax | 304-594-2408
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Provider Business Mailing Address
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Address Line | 123 PINE LANE
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City | MORGANTOWN
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State | WV
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Zip | 26508
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Country | US
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Telephone | 810-824-8066
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Fax | 304-243-3895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34126
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License Number State | WV
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