Provider Demographics
NPI:1407931637
Name:MAKI, DAVID C (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:MAKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-0671
Mailing Address - Country:US
Mailing Address - Phone:304-645-4043
Mailing Address - Fax:304-645-4713
Practice Address - Street 1:202 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:304-645-4043
Practice Address - Fax:304-645-4713
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV010089158OtherFEDERAL WKRS COMP/BL
WV1058353OtherWV WORKERS' COMP
462501OtherANTHEM BCBS
WV300126636OtherRAILROAD MCARE
55073865301OtherCHAMPUS
WV288546OtherMAMSI
WV0118716000Medicaid
WV000683460OtherMTN STATE BCBS
WV0698256Medicare ID - Type Unspecified
WV288546OtherMAMSI