Provider Demographics
NPI:1306921556
Name:WESTFALL, SUE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 CABIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DAWES
Mailing Address - State:WV
Mailing Address - Zip Code:25054-7700
Mailing Address - Country:US
Mailing Address - Phone:304-595-5006
Mailing Address - Fax:304-595-5007
Practice Address - Street 1:5722 CABIN CREEK ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:DAWES
Practice Address - State:WV
Practice Address - Zip Code:25054
Practice Address - Country:US
Practice Address - Phone:304-595-5006
Practice Address - Fax:304-595-5007
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000679730OtherMS BCBS
WV0054373000Medicaid
WV0763288Medicare ID - Type Unspecified
WV0054373000Medicaid