Provider Demographics
NPI:1841292786
Name:STRAIGHT, HEATHER (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STRAIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 N PLEASANTS HWY # 101
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-8511
Mailing Address - Country:US
Mailing Address - Phone:681-612-1022
Mailing Address - Fax:304-447-2556
Practice Address - Street 1:1861 N PLEASANTS HWY # 101
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-8511
Practice Address - Country:US
Practice Address - Phone:681-612-1022
Practice Address - Fax:304-447-2556
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008934207Q00000X
WV2007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2617118Medicaid
WV3810003181Medicaid
WV4132101Medicare PIN
WVI36019Medicare UPIN
WV3810003181Medicaid