Basic Information
| Provider Information | |||||||||
| NPI: | 1427480953 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH CHARLESTON FAMILY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 DIVISION ST | ||||||||
| Address2: | STE 205 | ||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253091455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047683941 | ||||||||
| FaxNumber: | 3047664391 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 DIVISION ST | ||||||||
| Address2: | STE 205 | ||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253091455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047683941 | ||||||||
| FaxNumber: | 3047664391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2013 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | WHITMAN | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3047683941 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.