Provider Demographics
NPI:1598798860
Name:GINGOLD, MONIQUE KOSSAK (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:KOSSAK
Last Name:GINGOLD
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 1:816 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2111
Mailing Address - Country:US
Mailing Address - Phone:304-599-5500
Mailing Address - Fax:304-599-6009
Practice Address - Street 1:816 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2111
Practice Address - Country:US
Practice Address - Phone:304-599-5500
Practice Address - Fax:304-599-6009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV167192084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0090246000Medicaid
WV0090246000Medicaid