Provider Demographics
NPI:1013993047
Name:MOWERY, DEBORAH THOREN (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:THOREN
Last Name:MOWERY
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 1:44 KINGSTON DR # 193
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-2574
Mailing Address - Country:US
Mailing Address - Phone:304-554-9494
Mailing Address - Fax:
Practice Address - Street 1:1160 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3437
Practice Address - Country:US
Practice Address - Phone:304-554-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29759208100000X
VA0101045890208100000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
216786OtherANTHEM
VA006800165Medicaid
VA1013993047Medicaid
250012231OtherMC RAILROAD
VA1013993047Medicaid
VAVV9408BMedicare PIN
216786OtherANTHEM
VAP01561007Medicare PIN