Provider Demographics
NPI:1932307063
Name:GAINER, MARY CONOR (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CONOR
Last Name:GAINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 W BLUEMONT ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1242
Mailing Address - Country:US
Mailing Address - Phone:304-265-0312
Mailing Address - Fax:304-265-0312
Practice Address - Street 1:2060 N MOUNTAINEER HWY
Practice Address - Street 2:
Practice Address - City:NEWBURG
Practice Address - State:WV
Practice Address - Zip Code:26410-8994
Practice Address - Country:US
Practice Address - Phone:304-892-2812
Practice Address - Fax:304-892-2814
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2023-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV24207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018609Medicaid
WV3810018609Medicaid
WV2033962Medicare PIN
WVP01142410Medicare PIN
WV2033961Medicare PIN