Provider Demographics
NPI:1568783702
Name:HAUGHT, MARCIA J (DO)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:J
Last Name:HAUGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:426 8TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1451
Mailing Address - Country:US
Mailing Address - Phone:304-221-4575
Mailing Address - Fax:304-221-4576
Practice Address - Street 1:426 8TH ST STE 301
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-221-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026308Medicaid
OH0088536Medicaid