Provider Demographics
NPI:1124553722
Name:PLACKE, ARIELLE ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:ELIZABETH
Last Name:PLACKE
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 1:6000 MEMORIAL CHURCH DR STE A
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-1503
Mailing Address - Country:US
Mailing Address - Phone:304-598-7313
Mailing Address - Fax:304-598-7319
Practice Address - Street 1:6000 MEMORIAL CHURCH DR STE A
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-1503
Practice Address - Country:US
Practice Address - Phone:304-598-7313
Practice Address - Fax:304-598-7319
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017575207Q00000X
WV3557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine