1427262765 NPI number — MEHRETTE M MARU MD

Table of content: JEANNIE L MCCARTER PH.D. (NPI 1528089646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427262765 NPI number — MEHRETTE M MARU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARU
Provider First Name:
MEHRETTE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427262765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1680
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25717-1680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-697-1396
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4270 US ROUTE 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-781-3610
Provider Business Practice Location Address Fax Number:
304-781-3611
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  22808 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3108247 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810018589 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00848497 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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