South Charleston Dermatology Pllc
NPI #1174604409 in South Charleston, West Virginia
Provider Information
- NPI Number
- 1174604409
- Entity Type
- Organization
- Organization Name
- South Charleston Dermatology Pllc
- Primary Specialty
- Dermatology
- Enumeration Date
- Oct 17, 2006
- Last Updated
- Dec 12, 2011
Practice Location
- Address
- 4815 KANAWHA AVE SW
- City
- South Charleston
- State
- West Virginia
- ZIP Code
- 25309-1207
- Phone
- (304) 768-4567
Authorized Official
- Name
- MRS. MICHELLE LEIGH ENDICOTT, DO
- Title
- OWNER/PHYSICIAN
- Phone
- (304) 768-4567
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dermatology |
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