Provider Demographics
NPI:1255303558
Name:CONTI, MARY E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:CONTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4114
Mailing Address - Country:US
Mailing Address - Phone:304-399-6501
Mailing Address - Fax:304-399-6528
Practice Address - Street 1:1400 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4114
Practice Address - Country:US
Practice Address - Phone:304-399-6501
Practice Address - Fax:304-399-6528
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050872174400000X
MOR5635174400000X
WV241662085R0001X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL27934OtherBLUE CROSS/BLUE SHIELD
ILP00128699OtherRAILROAD MEDICARE
MO203357447Medicaid
MO920001176OtherRAILROAD MEDICARE
MO203804OtherBLUE CROSS/BLUE SHIELD
MO27935OtherBLUE CHOICE
IL036050872Medicaid
MO203804OtherBLUE CROSS/BLUE SHIELD
MO920001176OtherRAILROAD MEDICARE
MO27935OtherBLUE CHOICE
MO001014907Medicare PIN
IL27934OtherBLUE CROSS/BLUE SHIELD