Provider Demographics
NPI:1659323301
Name:PLUNKETT, MARK A (MD OB/GYN)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:MD OB/GYN
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 9186
Mailing Address - Street 2:WVU DEPT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9186
Mailing Address - Country:US
Mailing Address - Phone:304-293-5631
Mailing Address - Fax:304-293-2131
Practice Address - Street 1:6600 VAN AALST BLVD
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-2102
Practice Address - Country:US
Practice Address - Phone:762-408-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70932207V00000X
WV24285207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200377920Medicaid
IN200377920Medicaid
IN193440Medicare ID - Type Unspecified