Provider Demographics
NPI:1669474755
Name:MACIUNAS, KRISTINIA (MD)
Entity type:Individual
Prefix:
First Name:KRISTINIA
Middle Name:
Last Name:MACIUNAS
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:PO BOX 1683
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-1683
Mailing Address - Country:US
Mailing Address - Phone:304-261-0313
Mailing Address - Fax:304-876-2001
Practice Address - Street 1:207 SOUTH PRINCESS STREET
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443
Practice Address - Country:US
Practice Address - Phone:304-261-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0045551000Medicaid
WVG12060Medicare UPIN
WV0045551000Medicaid