Provider Demographics
NPI:1720004559
Name:CONNER, DARCY M (DO)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:M
Last Name:CONNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:800 GRAND CENTRAL MALL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4100
Mailing Address - Country:US
Mailing Address - Phone:304-485-3300
Mailing Address - Fax:304-485-3317
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE 4
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4131
Practice Address - Country:US
Practice Address - Phone:304-485-3300
Practice Address - Fax:304-485-3317
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009130207Q00000X
WV2049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006180Medicaid
OH2835570Medicaid
WV4186631Medicare PIN
OH4221361Medicare PIN