Provider Demographics
NPI:1922067271
Name:SHILOBOD, MIA J (PA-C)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:J
Last Name:SHILOBOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 MEMORIAL CHURCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501
Mailing Address - Country:US
Mailing Address - Phone:304-292-7316
Mailing Address - Fax:304-599-8917
Practice Address - Street 1:1300 FORT PIERPONT DR STE 101
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-241-7150
Practice Address - Fax:304-599-8917
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV01143363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30074Medicare UPIN
P30074Medicare UPIN