Provider Demographics
NPI:1346273471
Name:DUKART, WILLIAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:DUKART
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 1:200 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1334
Practice Address - Country:US
Practice Address - Phone:304-647-1146
Practice Address - Fax:304-647-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV370004014OtherRAILROAD MEDICARE
WV58183OtherSOUTHERN HEALTH
WV282375OtherANTHEM BCBS
WV849938OtherMAMSI
WV997126001OtherCIGNA
WV0112336000Medicaid
WV007OtherMTST BCBS
WV4502186OtherAETNA
WVDU0655851Medicare ID - Type Unspecified
WV4502186OtherAETNA
WV997126001OtherCIGNA