Individual
DR. MACKENZIE LEE MINCEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
110 SIMS CIRCLE, TRIADELPHIA, WV 26059-1154
(304) 599-8000
(304) 599-8003
Mailing address
1247 SUNCREST TOWN CENTRE DR, MORGANTOWN, WV 26505-1876
(304) 599-8000
(304) 599-8003
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
26742
WV
208000000X
Pediatrics Physician
28153
SC
208000000X
Pediatrics Physician
35127525
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0170258
—
OH
05
—
1659405249
—
WV
05
—
281536
—
SC
Enumeration date
03/15/2007
Last updated
04/01/2020
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