Individual
DR. JAMES NAMSUPAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 GUFFEY ST, JOHN MANCHIN SR. HEALTH CARE CENTER, FAIRMONT, WV 26554-4029
(304) 363-2500
Mailing address
401 GUFFEY ST, FAIRMONT, WV 26554-4029
(304) 363-2500
(304) 363-0263
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23919
WV
208D00000X
General Practice Physician
Primary
23919
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810016983
—
WV
Enumeration date
05/08/2008
Last updated
09/16/2013
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