Basic Information
| Provider Information | |||||||||
| NPI: | 1609809219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | MIRIAM | ||||||||
| MiddleName: | KATHERINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 TECHNOLOGY DR | ||||||||
| Address2: | STE 2320 | ||||||||
| City: | FAIRMONT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265548824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043682781 | ||||||||
| FaxNumber: | 3043682759 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 CHEAT RD | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265084210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045941313 | ||||||||
| FaxNumber: | 3045942408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22331 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.