DR. DEIDRA FAWN MUTO (NPI# 1609164227) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609164227 |
| Entity Type | Individual |
| Full Name | DR. DEIDRA FAWN MUTO |
| Other Name | DR. DEIDRA FAWN NAYLOR |
| Credential | M.D. |
| Practice Address |
219 Georgetown Pl Charleston WV 25314-1871 |
| Practice Telephone | 3045432663 |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2011-07-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
21492 | SC | Allopathic & Osteopathic Physicians |
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
21489 | WV | Allopathic & Osteopathic Physicians |
| Street Address |
219 GEORGETOWN PL |
| City | CHARLESTON |
| State | WV |
| Zip Code | 25314-1871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265033559 | Nancy Galvan | Technician | 4587 Kanawha State Forrest Dr., Charleston, WV 25314 | 2020-11-04 |
| 1093316424 | Emma Mccloud | Technician | 710 Colony Dr., Charleston, WV 25314 | 2020-11-03 |
| 1699376137 | Amanda Gail Evans | Technician | 11 Happy Hl, Charleston, WV 25314 | 2020-11-02 |
| 1457879074 | Samantha Pennington | Pharmacist | 1100 Fledderjohn Rd Kroger #785, Charleston, WV 25314 | 2017-09-04 |
| 1992180335 | John Anthony Palmer IIi | Dentist | 867 Oakwood Road, Charleston, WV 25314 | 2015-07-28 |
| 1285039727 | West Virginia Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 885 Oakwood Rd., Charleston, WV 25314 | 2014-10-27 |
| 1386980381 | Miranda L Broyles | Nurse Practitioner | 3200 Maccorkle Avenue Southwest, Charleston, WV 25314 | 2012-12-19 |
| 1548482896 | Christina M. Arco, Phd Pllc | Psychologist | 1013 B Oakhurst Drive, Charleston, WV 25314 | 2007-05-03 |
| 1578780359 | S & W Meeks Inc | Eyewear Supplier (Equipment, not the service) | 426 Division Street, South Charleston, WV 25314 | 2007-04-20 |
| 1669511853 | Gregory Alan Simmerman | Audiologist | 1105 Fledderjohn Road, Charleston, WV 25314 | 2007-02-05 |
| Find all providers in zip 25314 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932691094 | Yanna Ding | Pathology | 169 Ashley Avenue, Room 202 Main Hospital, Msc333, Charleston, SC 29425 | 2018-06-05 |
| 1972732162 | Kalli Kole Faulkner | Pathology | 218 Children's Hospital, 171 Ashley Avenue. Msc 908, Charleston, SC 29464 | 2009-07-08 |
| 1942409719 | Raford Porter Rogers IIi | Pathology | 165 Ashley Ave Ste 309, Charleston, SC 29425-8905 | 2007-07-12 |
| 1316063944 | Johann Hertel | Pathology | 165 Ashley Avenue, Suite 337, Charleston, SC 29425 | 2007-03-22 |
| 1861575813 | Mary Kathleen Wren | Pathology | 171 Ashley Ave, Msc 908, Department of Pathology, Charleston, SC 29425-8905 | 2006-10-23 |
| 1699743344 | Joseph F Valicenti Jr. | Pathology | 9330 Medical Plaza Drive, Department of Pathology, Charleston, SC 29418-9195 | 2006-03-09 |
| 1720087596 | Charleston Pathology Associates Pllc | Pathology | 333 Laidley St, Charleston, WV 25301-1614 | 2005-07-14 |
| 1730703844 | Elicia Goodale | Pathology | 171 Ashley Ave # Msc908, Charleston, SC 29425-0100 | 2020-06-04 |
| 1598389975 | Chelsea Kramish | Pathology | 169 Ashley Ave Rm 202, Charleston, SC 29425-8905 | 2020-06-02 |
| 1366066631 | Ivana Hernandez | Pathology | 169 Ashley Ave Rm 202, Charleston, SC 29425-8905 | 2020-06-02 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 25314 |
Please comment or provide details below to improve the information on DR. DEIDRA FAWN MUTO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.