Provider Demographics
NPI:1750478269
Name:HESS, MICHAEL RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:HESS
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:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0763
Mailing Address - Country:US
Mailing Address - Phone:800-541-4009
Mailing Address - Fax:
Practice Address - Street 1:401 N PIKE ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1268
Practice Address - Country:US
Practice Address - Phone:304-265-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV20011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3002032000Medicaid
WVWV1205AMedicare PIN
WVH35486Medicare UPIN
WVWV20011OtherHEALTH PLAN
WVSP00601Medicare ID - Type UnspecifiedGROUP #
WV51DO988462OtherCLIA
WV7083657002OtherCIGNA
WVHE4047991Medicare ID - Type UnspecifiedINDIVIDUAL #
WV7208263OtherAETNA