Basic Information
| Provider Information | |||||||||
| NPI: | 1477940922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDEN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LESLIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 SOMERSET BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | CHARLES TOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254143953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047252663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 912 SOMERSET BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHARLES TOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047252663 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 08/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 210048 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 11725386-1205 | UT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 30403 | WV | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.