Provider Demographics
NPI:1225024755
Name:CHOUEIRI, MARK ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:CHOUEIRI
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 1:3100 MACCORKLE SEAVE 408
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1230
Mailing Address - Country:US
Mailing Address - Phone:304-388-5120
Mailing Address - Fax:304-388-5125
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:STE 408
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-388-5280
Practice Address - Fax:304-388-5291
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21843208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003516Medicaid
P00273599OtherRAILROAD MEDICARE
H20700Medicare UPIN
CH4170271Medicare PIN
P00273599OtherRAILROAD MEDICARE