Basic Information
| Provider Information | |||||||||
| NPI: | 1154381796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIRONA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ROSALIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 HAL GREER BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257014114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043996610 | ||||||||
| FaxNumber: | 3043996621 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 HAL GREER BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257014114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043996610 | ||||||||
| FaxNumber: | 3043996621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 16989 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1806454000 | 05 | WV | MEDICAID | 2270359 | 05 | OH | MEDICAID | 64039068 | 05 | KY | MEDICAID |