Provider Demographics
NPI:1043832389
Name:DEBORAH T MOWERY MD PLLC
Entity type:Organization
Organization Name:DEBORAH T MOWERY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:THOREN
Authorized Official - Last Name:MOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-554-9494
Mailing Address - Street 1:44 KINGSTON DR # 193
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-2574
Mailing Address - Country:US
Mailing Address - Phone:304-554-9494
Mailing Address - Fax:
Practice Address - Street 1:1160 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3437
Practice Address - Country:US
Practice Address - Phone:304-554-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-09
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty