Provider Demographics
NPI:1528131703
Name:MAYLE, MARK D (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:MAYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2713
Mailing Address - Country:US
Mailing Address - Phone:304-598-3301
Mailing Address - Fax:304-599-7346
Practice Address - Street 1:1255 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2713
Practice Address - Country:US
Practice Address - Phone:304-598-3301
Practice Address - Fax:304-599-7346
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17989207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096228000Medicaid
MD515261500Medicaid
PA15715140003Medicaid
PA15715140004Medicaid
PA15715140003Medicaid
G23146Medicare UPIN
MD055LF476Medicare ID - Type Unspecified
WV0096228000Medicaid
WV0798662Medicare ID - Type Unspecified
WV0798661Medicare ID - Type Unspecified
WV0693170002Medicare NSC