Provider Demographics
NPI:1225092638
Name:FRANZ, AGNES MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:MARIE
Last Name:FRANZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 LOCUST AVE
Mailing Address - Street 2:PO BOX 1112
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-366-0700
Mailing Address - Fax:304-366-9529
Practice Address - Street 1:1322 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-366-0700
Practice Address - Fax:304-366-9529
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV505813OtherNATIONAL CAPITAL PPO
WV0111331000Medicaid
WV0839302OtherMEDICARE PTAN
WVF74939OtherCARELINK
WV001718666OtherMT STATE BS/BC
WV370017784OtherRR MEDICARE
WV0004642760OtherAETNA
WV0573001OtherHOME PLAN PEIA AND CHIPS
WVFQ13128OtherHEALTH PLAN
WVFR0839301Medicare PIN
WVFQ13128OtherHEALTH PLAN