Individual
DR. DEIDRA FAWN MUTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
219 GEORGETOWN PL, CHARLESTON, WV 25314-1871
(304) 543-2663
Mailing address
219 GEORGETOWN PL, CHARLESTON, WV 25314-1871
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
21489
WV
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
21492
SC
Other
Enumeration date
07/17/2011
Last updated
07/17/2011
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