Provider Demographics
NPI:1770664609
Name:FUNK, CATHY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MARIE
Last Name:FUNK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:MARIE
Other - Last Name:FUNK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:
Mailing Address - Fax:
Practice Address - Street 1:2000 PROFESSIONAL CT
Practice Address - Street 2:SUITE A
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8803
Practice Address - Country:US
Practice Address - Phone:304-264-9837
Practice Address - Fax:304-264-9838
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2003209000Medicaid
4086711Medicare PIN
WVH64738Medicare UPIN