Provider Demographics
NPI:1659329761
Name:KITZMILLER, MELISSA DAWN (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:KITZMILLER
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 1:22347 NORTHWESTERN PIKE
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-6343
Mailing Address - Country:US
Mailing Address - Phone:304-822-3838
Mailing Address - Fax:304-822-7665
Practice Address - Street 1:422S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1238
Practice Address - Country:US
Practice Address - Phone:304-538-2331
Practice Address - Fax:304-538-2663
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20333208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659329761OtherNPI
WV1840904000Medicaid
WV9189782Medicare PIN
1659329761OtherNPI