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Contact Information

PEDIATRIC GASTROENTEROLOGY OF CHARLESTON, PLLC
428 DIVISION ST
SUITE 3A
SOUTH CHARLESTON, WV25309-1469
 Phone: 304-400-4626
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Gastroenterology

2080P0206X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PEDIATRIC GASTROENTEROLOGY OF CHARLESTON PLLC · (Female)

NPI # 1609216605
Status Active
Credentials
Entity Individual
Enumeration date 07/05/2013
Last updated 11/26/2013 - About 13 years ago
Sole proprietor 1 Not specified
Identifiers
  • WV License # 24418
  • WV Medicaid 381002088
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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