Individual
DR. KATHLEEN MIMNAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3200 MACCORKLE AVE, CAMC -MEMORIAL HOSPITAL, ADMINISTRATION, CHARLESTON, WV 25304
(304) 388-4377
(304) 388-9633
Mailing address
1518 COVENTRY LN, CHARLESTON, WV 25314-2484
(304) 744-4496
(304) 388-9633
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16906
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078598000
—
WV
01
—
4263984
AETNA
—
01
—
MAMSI
292056
—
Enumeration date
08/03/2006
Last updated
07/08/2007
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