Provider Demographics
NPI:1326141391
Name:STATON, MICHELE DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DAWN
Last Name:STATON
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 1:2401 S KANAWHA ST
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6967
Mailing Address - Country:US
Mailing Address - Phone:304-929-4646
Mailing Address - Fax:304-929-4649
Practice Address - Street 1:2401 S KANAWHA ST
Practice Address - Street 2:SUITE 110A
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6967
Practice Address - Country:US
Practice Address - Phone:304-929-4646
Practice Address - Fax:304-929-4649
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23359208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics