Deidra Fawn Muto, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

21489 Issued in WV

Practice address

219 Georgetown PL
Charleston, WV 25314-1871

Phone

(304) 543-2663

NPI assigned

Jul 17, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Deidra Fawn Naylor Former name

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• THS Physician Partners Inc

  • Internal Medicine Physician
  • South Charleston, WV
  • NPI 1871866806
  NPD
• Charleston Pathology Associates PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Charleston, WV
  • NPI 1720087596
  NPD (past)
• Charleston Area Medical Center Inc

  • Multi-Specialty Clinic/Center
  • Belpre, OH
  • NPI 1588422547
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310860800000",
    "number": "1609164227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 GEORGETOWN PL",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 GEORGETOWN PL",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141871",
            "telephone_number": "304-543-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTO",
        "first_name": "DEIDRA",
        "middle_name": "FAWN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-17",
        "last_updated": "2011-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WV",
            "license": "21489",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "SC",
            "license": "21492",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEIDRA",
            "last_name": "NAYLOR",
            "middle_name": "FAWN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristopher Musick, PA
• Pamela A Musick, RN
• Muhammad Mussa, M.D.
• Mustard Seed Counseling and Behavioral Health Services LLC
• Amber Lynn Mutimer, APRN, NP-C
• Frank A. Muto, M.D.
• My September LLC
• My Vein Care, Inc.
• Chan Myae, MD
• Rain Myatt

• Anatomic Pathology & Clinical Pathology Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Anatomic Pathology & Clinical Pathology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.