Provider Demographics
NPI:1861598518
Name:GANT, DARLA KAY (MD)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:KAY
Last Name:GANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:KAY
Other - Last Name:PIGOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0763
Mailing Address - Country:US
Mailing Address - Phone:800-541-4009
Mailing Address - Fax:
Practice Address - Street 1:626 ELK ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1136
Practice Address - Country:US
Practice Address - Phone:304-364-2401
Practice Address - Fax:304-364-2441
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1840683000Medicaid
WV4081641Medicare PIN
H60740Medicare UPIN
WV080187891Medicare PIN