Provider Demographics
NPI:1013991355
Name:MAOUAD, MICHELE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
Last Name:MAOUAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SUNCREST TOWN CENTRE DR STE 115
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1873
Mailing Address - Country:US
Mailing Address - Phone:304-598-3888
Mailing Address - Fax:304-598-0564
Practice Address - Street 1:600 SUNCREST TOWN CENTRE DR STE 115
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1873
Practice Address - Country:US
Practice Address - Phone:304-598-3888
Practice Address - Fax:304-598-0564
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21247207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7061507OtherAETNA
WV3810002533Medicaid
WV001751643OtherBCBS
WVWV21249AOtherHEALTH PLAN
WVMA4109532Medicare ID - Type Unspecified
WV3810002533Medicaid