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General NPI Number Information
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NPI Number | 1669474755
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Entity Type | Individual
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Provider Name | KRISTINIA MACIUNAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 207 SOUTH PRINCESS STREET
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443
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Country | US
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Telephone | 304-261-0313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1683
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-1683
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Country | US
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Telephone | 304-261-0313
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Fax | 304-876-2001
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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 | 14514
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License Number State | WV
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