Provider Demographics
NPI:1992782031
Name:DUFF, MARK (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DUFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:WV
Mailing Address - Zip Code:24924-9037
Mailing Address - Country:US
Mailing Address - Phone:304-799-1090
Mailing Address - Fax:304-799-6636
Practice Address - Street 1:150 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924
Practice Address - Country:US
Practice Address - Phone:304-799-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03315207Q00000X
WV1446208M00000X, 207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100046790Medicaid
WV001714924OtherWV BCBS
WV1064385OtherWV DWC
OH2851838Medicaid
KYP00881466OtherRR MEDICARE
WV001722627OtherBLUE CROSS BLUE SHIELD
WV0045353000Medicaid
KY7100046790Medicaid
KYP400031925Medicare PIN
WVP00179776Medicare PIN
WVP00388488Medicare PIN
WV001722627OtherBLUE CROSS BLUE SHIELD
WVDU0804307Medicare PIN
WV1064385OtherWV DWC
OH2851838Medicaid