Individual
DR. SEAN CHARLES DICRISTOFARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 STATION PLACE WAY, HURRICANE, WV 25526-8747
(304) 757-7788
(304) 201-1140
Mailing address
104 STATION PLACE WAY, HURRICANE, WV 25526-8747
(304) 757-7788
(304) 201-1140
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
WV19679
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5630468000
—
WV
Enumeration date
03/20/2006
Last updated
11/12/2007
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