Provider Demographics
NPI:1639140759
Name:SOKOS, MATHEW GUS (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:GUS
Last Name:SOKOS
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 1:58 16TH STREET
Mailing Address - Street 2:WHEELING CLINIC
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-234-2004
Mailing Address - Fax:304-234-2006
Practice Address - Street 1:58 16TH STREET
Practice Address - Street 2:WHEELING CLINIC
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-234-2004
Practice Address - Fax:304-234-2006
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0875021Medicaid
WV0053312000Medicaid
WV0053312000Medicaid
WVS00712522Medicare ID - Type Unspecified