Individual
DEBORAH A WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
700 VILLAGE DR, FAIRMONT, WV 26554-7985
(304) 366-2600
Mailing address
PO BOX 890707, CHARLOTTE, NC 28289-0707
(866) 338-6463
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
11984
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0123357000
—
WV
Enumeration date
07/20/2005
Last updated
07/19/2007
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