# WEST VIRGINIA DERMATOLOGY AND SKIN SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** West Virginia Dermatology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174881916
- **Authorized official:** DR. DAVID W JUDY D.O. (OWNER)
- **Authorized official phone:** (304) 925-7546

## Contact information

- **Practice address:** 4202 MACCORKLE AVE SW STE 200, SOUTH CHARLESTON, WV 25309-1513
- **Practice address phone:** (304) 925-7546
- **Practice address fax:** (681) 205-8369
- **Mailing address:** 4202 MACCORKLE AVE SW STE 200, SOUTH CHARLESTON, WV 25309-1513
- **Mailing address phone:** (304) 925-7546
- **Mailing address fax:** (681) 205-8369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 2596 | WV | Yes |

## Other

- **Enumeration date:** 04/30/2012
- **Last updated:** 01/06/2020