Provider Demographics
NPI:1316436694
Name:REZA, ERONA (MBBS, CCFP)
Entity type:Individual
Prefix:
First Name:ERONA
Middle Name:
Last Name:REZA
Suffix:
Gender:F
Credentials:MBBS, CCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 UNIVERSITY TOWN CENTRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2421
Mailing Address - Country:US
Mailing Address - Phone:304-598-6900
Mailing Address - Fax:304-285-7372
Practice Address - Street 1:6040 UNIVERSITY TOWN CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2421
Practice Address - Country:US
Practice Address - Phone:304-598-6900
Practice Address - Fax:304-285-7372
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1013207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine