Provider Demographics
NPI:1144515180
Name:LOUNDER, DANA TIBERIO (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:TIBERIO
Last Name:LOUNDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:MICHELE
Other - Last Name:TIBERIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3710 PENNSYLVANIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4129
Mailing Address - Country:US
Mailing Address - Phone:304-914-3893
Mailing Address - Fax:304-844-9562
Practice Address - Street 1:3710 PENNSYLVANIA AVE STE B
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-914-3893
Practice Address - Fax:304-844-9562
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123668208000000X
WV27589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics