Provider Demographics
NPI:1194894477
Name:SOTOMAYOR, TALIA B (MD)
Entity type:Individual
Prefix:DR
First Name:TALIA
Middle Name:B
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:B
Other - Last Name:SOTOMAYOR VALENZUELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1100 FORT PIERPONT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1329
Mailing Address - Country:US
Mailing Address - Phone:304-284-8999
Mailing Address - Fax:304-284-9777
Practice Address - Street 1:1100 FORT PIERPONT DR STE 102
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1329
Practice Address - Country:US
Practice Address - Phone:304-284-8999
Practice Address - Fax:304-284-9777
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV225242080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3910006278Medicaid
WV3810006966Medicaid
WV3910006278Medicaid
WVSO6035061Medicare PIN