Provider Demographics
NPI:1265172654
Name:MCCAUSLEY, CORY
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:MCCAUSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLD FIELDS
Mailing Address - State:WV
Mailing Address - Zip Code:26845-9110
Mailing Address - Country:US
Mailing Address - Phone:304-851-1682
Mailing Address - Fax:
Practice Address - Street 1:7 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1796
Practice Address - Country:US
Practice Address - Phone:130-425-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist