Individual
DR. MARK A HACKNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 VILLAGE DR, FAIRMONT, WV 26554-7985
(304) 366-2600
(304) 366-2080
Mailing address
PO BOX 890707, CHARLOTTE, NC 28289-0707
(866) 338-6463
(614) 717-9840
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01061747A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
20963
WV
2085R0202X
Diagnostic Radiology Physician
35.087295
OH
2085R0202X
Diagnostic Radiology Physician
36114676
IL
2085R0202X
Diagnostic Radiology Physician
TP199
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000163377
UNISON FORMERLY 3 RIVERS
—
01
—
000000384890
BCBS
OH
01
—
1065856
WV WORKERS COMP
WV
05
—
3810001885
—
WV
Enumeration date
05/04/2006
Last updated
07/19/2007
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