WEST VIRGINIA DERMATOLOGY AND SKIN SURGERY CENTER (NPI# 1174881916) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174881916 |
| Entity Type | Organization |
| Organization Name | WEST VIRGINIA DERMATOLOGY AND SKIN SURGERY CENTER |
| Other Organization Name | WEST VIRGINIA DERMATOLOGY |
| Practice Address |
4202 Maccorkle Ave Sw Ste 200 South Charleston WV 25309-1513 |
| Practice Telephone | 3049257546 |
| Practice Fax Number | 6812058369 |
| Mailing Telephone | 3049257546 |
| Mailing Fax Number | 6812058369 |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2020-01-06 |
| Authorized Official Name | DR. DAVID W JUDY (OWNER) |
| Authorized Official Telephone | 3049257546 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
2596 | WV | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| West Virginia Dermatology | Other Name - Individual/Organization |
| Street Address |
4202 MACCORKLE AVE SW STE 200 |
| City | SOUTH CHARLESTON |
| State | WV |
| Zip Code | 25309-1513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437361284 | Deborah L Klimek, Md, Pllc | Clinic/Center | 24 Maccorkle Ave Sw, Suite 203, South Charleston, WV 25303-1476 | 2007-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275150351 | Wv Wellness and Recovery LLC | Clinic/Center | 4 Putnam Village Drive, Hurricane, WV 25526 | 2020-07-06 |
| 1376829671 | Kidney Specialists, Pllc | Clinic/Center | 176 Health Care Ln Ste A, Martinsburg, WV 25401-4010 | 2011-10-31 |
| 1326166463 | Kanawha Valley Neurology | Clinic/Center | 3847 Teays Valley Rd, Suite D, Hurricane, WV 25526-9622 | 2007-03-27 |
| 1982604997 | Mountain State Ent & Facial Plastic Surgery, Inc | Clinic/Center | 86 Brookshire Ln, Beckley, WV 25801-6765 | 2005-08-01 |
| 1356349161 | Grant Memorial Hospital | Clinic/Center | 1 Hospital Drive, Petersburg, WV 26847 | 2005-07-14 |
| 1346248283 | Grant Memorial Hospital | Clinic/Center | 10 Valley View St, Suite 101, Petersburg, WV 26847-9543 | 2005-07-13 |
| 1013557982 | Mountaineer Wellness and Recovery Centers LLC | Clinic/Center | 310 George St, Beckley, WV 25801-2653 | 2020-01-08 |
| 1609333830 | House of Grace LLC | Clinic/Center | 401 Camden Rd, Huntington, WV 25704-2708 | 2019-02-25 |
| 1811405616 | Holistic, Inc | Clinic/Center | 303 6th Ave, Saint Albans, WV 25177-2838 | 2018-01-15 |
| 1891220695 | Valley Family Medicine Pllc | Clinic/Center | 215 S Louisiana Ave Ste A, Martinsburg, WV 25401-2023 | 2017-04-29 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH CHARLESTON |
| Zip Code | 25309 |
Please comment or provide details below to improve the information on WEST VIRGINIA DERMATOLOGY AND SKIN SURGERY CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.