MEDICARE: MARY S PAYNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	04-52411	KS
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	23011	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316138324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY S PAYNE MD

Provider Business Mailing Address
First Line	:	1600 MEDICAL CENTER DR
Second Line	:	STE B500
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3656
Country	:	US
Telephone Number	:	304-691-1787
Fax Number	:	304-691-8711

Provider Business Practice Location Address
First Line	:	1600 MEDICAL CENTER DR
Second Line	:	STE B500
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3656
Country	:	US
Telephone Number	:	304-691-1787
Fax Number	:	304-691-8711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	03/09/2026

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Directions to “ MARY S PAYNE MD” Practice Location

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