Provider Demographics
NPI:1407843832
Name:FOX, MICHELLE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0763
Mailing Address - Country:US
Mailing Address - Phone:800-541-4009
Mailing Address - Fax:
Practice Address - Street 1:407 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1536
Practice Address - Country:US
Practice Address - Phone:304-845-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2003105000Medicaid
WV20824OtherHEALTH PLAN
WV236944199OtherTRICARE
WV2179887OtherFIRST HEALTH
WV2335486OtherOHIO MEDICAID
WV383653649-001OtherMEDICAL MUTUAL
WV5204621-004OtherCIGNA
WV5445975OtherCCN
WV001716693OtherBC BS
WV20824Other4-MOST
WV897797OtherMAMSI
WV186136OtherCARELINK
WV5445975OtherCCN
WV383653649-001OtherMEDICAL MUTUAL