=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437184462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY LOU FRAGILE DO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RR 2 BOX 171C GREYROCK PROF PARK
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-647-3331
-----------------------------------------------------
Fax | 304-647-9799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1788
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-647-3331
-----------------------------------------------------
Fax | 304-647-9799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DO FAMILY PRACTICE
-----------------------------------------------------
Name | DR. MARY LOU FRAGILE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 304-647-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------