Individual provider Active NPI

Christina Dague, PA-C

  • Physician Assistant
  • Weirton, WV
National Provider Identifier
1720102080
Registry record updated Sep 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
00971 Issued in WV
Practice address
3045 Pennsylvania Ave Ste 3
Weirton, WV 26062-3770
Phone
(304) 723-4000
Fax
(304) 723-4003
NPI assigned
Mar 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 00971 WV Primary

Addresses

Primary practice location

3045 Pennsylvania Ave Ste 3
Weirton, WV 26062-3770

Mailing address

3045 Pennsylvania Ave Ste 3
Weirton, WV 26062-3770
Phone (304) 723-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221108003042 WV Practitioner - Physician Assistant 1153798970 Reassigns benefits to 2 organizations
I20221115000051 PA Practitioner - Physician Assistant 1153798970 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
00971WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fayette Physician Network Inc Physician Assistant CurrentSince Oct 26, 2022 Accepting new patients
Fayette Physician Network Inc CurrentSince Oct 26, 2022 Accepting new patients
Fayette Physician Network Inc Past Accepting new patients

Locations

3 Robinson Plz
Ste 100
Pittsburgh, PA 15205
Phone (304) 723-4000

201 Mary Higginson Ln
Uniontown, PA 15401
Phone (724) 430-5940

800 Garfield Ave
Parkersburg, WV 26101
Phone (304) 420-7161

3045 Pennsylvania Ave
Ste 3
Weirton, WV 26062
Phone (304) 723-4000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1720102080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3045 PENNSYLVANIA AVE STE 3",
            "city": "WEIRTON",
            "state": "WV",
            "postal_code": "260623770",
            "telephone_number": "304-723-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 PENNSYLVANIA AVE STE 3",
            "city": "WEIRTON",
            "state": "WV",
            "postal_code": "260623770",
            "telephone_number": "304-723-4000",
            "fax_number": "304-723-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGUE",
        "first_name": "CHRISTINA",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "00971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weirton, WV

Sources for this page

Verify at the official NPI Registry.