Active NPI
Mary Anne Fahey
- Speech-Language Pathologist
- Martinsburg, WV
National Provider Identifier
1104099563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 0609
- Practice address
- 401 South Queen Street
Berkeley County Board of Education
Martinsburg, WV 25401 - Phone
- (304) 267-3500
- NPI assigned
- Apr 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 0609 | WV | Primary |
Addresses
Primary practice location
401 South Queen Street
Berkeley County Board of Education
Martinsburg, WV 25401
Mailing address
814 Woodland Way
Hagerstown, MD 21742
Phone (301) 739-0756
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0153459000 | Medicaid | WV |
Other names 1
- Mary Anne Shorb
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0609 | WV | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1104099563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 WOODLAND WAY",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "21742",
"telephone_number": "301-739-0756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 SOUTH QUEEN STREET",
"address_2": "BERKELEY COUNTY BOARD OF EDUCATION",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "25401",
"telephone_number": "304-267-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAHEY",
"first_name": "MARY",
"middle_name": "ANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-08",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WV",
"license": "0609",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0153459000",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "SHORB",
"middle_name": "ANNE",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.