Provider Demographics
NPI:1477520419
Name:FIERY, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:FIERY
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25708-0366
Mailing Address - Country:US
Mailing Address - Phone:304-522-8311
Mailing Address - Fax:304-522-8313
Practice Address - Street 1:1508 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2902
Practice Address - Country:US
Practice Address - Phone:304-522-8311
Practice Address - Fax:304-522-8313
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11555207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0512056Medicaid
WV0096785000Medicaid
180000154Medicare ID - Type UnspecifiedR/R MEDICARE
WV0096785000Medicaid
A72136Medicare UPIN