| Dimitri Misailidis, MD | |
|
300 Foxcroft Ave, Suite 202b, Martinsburg, WV 25401-5341 | |
| (304) 263-4967 | |
| (304) 267-5461 |
| Full Name | Dimitri Misailidis |
|---|---|
| Gender | Male |
| Speciality | Radiology - Diagnostic Radiology |
| Location | 300 Foxcroft Ave, Martinsburg, West Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053356204 | NPI | - | NPPES |
| 000848955 | Other | WV | WV BCBS |
| 0118129000 | Medicaid | WV | |
| 535851500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 15875 (West Virginia) | Primary |
| Entity Name | West Virginia University Medical Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1275504508 PECOS PAC ID: 1052224565 Enrollment ID: O20031111000207 |
| Mailing Address | Practice Location Address |
|---|---|
| Dimitri Misailidis, MD 300 Foxcroft Ave, Suite 202b, Martinsburg, WV 25401-5341 Ph: (304) 263-4967 | Dimitri Misailidis, MD 300 Foxcroft Ave, Suite 202b, Martinsburg, WV 25401-5341 Ph: (304) 263-4967 |
Dr. David Long Lawrence, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 510 Butler Ave, Imaging Service, Martinsburg, WV 25401 Phone: 304-263-0811 | |
John Louis Blanco, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 300 Foxcroft Ave, Suite 202b, Martinsburg, WV 25401 Phone: 304-263-4967 Fax: 304-267-0974 | |
Dr. Peter Markovic, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 510 Butler Ave, Imaging Service, Martinsburg, WV 25401 Phone: 304-263-0811 | |
Edward W. Kiggundu, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 2000 Foundation Way, Suite 1100, Martinsburg, WV 25401 Phone: 304-262-8800 Fax: 304-262-8203 | |
Dr. Vivek Padha, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 2500 Hospital Dr, Martinsburg, WV 25401 Phone: 304-596-6828 Fax: 304-596-5112 | |
Hojoon Jung, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 300 Foxcroft Ave, Suite 202b, Martinsburg, WV 25401 Phone: 304-263-4967 Fax: 304-267-5461 |