Provider Demographics
NPI:1578524195
Name:PEARSON, AMY BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AMALIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2239
Mailing Address - Country:US
Mailing Address - Phone:304-473-2000
Mailing Address - Fax:
Practice Address - Street 1:21 AUCTION LANE
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2236
Practice Address - Country:US
Practice Address - Phone:304-472-6041
Practice Address - Fax:304-517-8901
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5630443000Medicaid
WVPE4018812Medicare ID - Type Unspecified
WVG63244Medicare UPIN