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NPI Code Detail

MEDICARE: MOUNTAIN STATE MEDICINE AND RHEUMATOLOGY PLLC

MEDICARE: MOUNTAIN STATE MEDICINE AND RHEUMATOLOGY PLLC
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
1332900000XNon-Pharmacy Dispensing Site
2174400000XSpecialist1818WV
3207RR0500XRheumatology Physician
4174400000XSpecialist1767WV
5363LF0000XFamily Nurse Practitioner
6363L00000XNurse Practitioner
7207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1982720801
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN STATE MEDICINE AND RHEUMATOLOGY PLLC
Provider Business Mailing Address
First Line : 1120 KANAWHA BLVD E STE 200
Second Line :
City : CHARLESTON
State : WV
Zip : 25301-2400
Country : US
Telephone Number : 304-400-4900
Fax Number : 304-400-4907
Provider Business Practice Location Address
First Line : 1120 KANAWHA BLVD E STE 200
Second Line :
City : CHARLESTON
State : WV
Zip : 25301-2400
Country : US
Telephone Number : 304-400-4900
Fax Number : 304-400-4907
Authorized Official
Title or Position : PRACTICE MANAGER
Name : DOSHIA K PETRY WARD
Credential : CMOM, CMC,CMPM, CMA
Telephone Number : 304-400-4900
Provider Enumeration Date : 03/22/2007
Last Update Date : 01/12/2026

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1093719635 — DR. MARY H.L. MCJUNKIN M.D.
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Directions to “MOUNTAIN STATE MEDICINE AND RHEUMATOLOGY PLLC ” Practice Location

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