Wanetta Susie Matulis, MD

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

14892 Issued in WV

Practice address

68 Quarry RDG
Charleston, WV 25304-1051

Phone

(304) 344-5000

NPI assigned

Nov 12, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Modi Medical Corporation

  • Infectious Disease Physician
  • South Charleston, WV
  • NPI 1528178076
  NPD (past)

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

{
    "created_epoch": "1352678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352678400000",
    "number": "1669716833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 QUARRY RDG",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041051",
            "telephone_number": "304-344-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 QUARRY RDG",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041051",
            "telephone_number": "304-344-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATULIS",
        "first_name": "WANETTA",
        "middle_name": "SUSIE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-12",
        "last_updated": "2012-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "WV",
            "license": "14892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyvia Matlock
• Matthew Shaffer MD PLLC
• Chasity Matthews
• Debora Mattingly, PT
• Steven Robert Matulis, MD
• Sarah Mauller
• Devyn Brooke Maurath
• James Patrick Maurer, D.O.
• Mary Ann Maurer, DO
• John Mauzy

• Infectious Disease Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Infectious Disease Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.