Provider Demographics
NPI:1124072905
Name:POZEGA, MARY C (DO)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:POZEGA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6637 KANAWHA AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2915
Mailing Address - Country:US
Mailing Address - Phone:304-926-6637
Mailing Address - Fax:
Practice Address - Street 1:5324 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2222
Practice Address - Country:US
Practice Address - Phone:304-925-7001
Practice Address - Fax:304-925-7234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics