Organization
ABC PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH MATUSIC M.D. (PHYSICIAN)
(304) 343-1863
Entity
Organization
Contact information
Practice address
830 PENNSYLVANIA AVE, SUITE 200, CHARLESTON, WV 25302-3302
(304) 343-1863
(304) 344-1755
Mailing address
830 PENNSYLVANIA AVE, SUITE 200, CHARLESTON, WV 25302-3302
(304) 343-1863
(304) 344-1755
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
1451
WV
208000000X
Pediatrics Physician
15140
WV
208000000X
Pediatrics Physician
16381
WV
208000000X
Pediatrics Physician
18217
WV
208000000X
Pediatrics Physician
Primary
731
WV
291U00000X
Clinical Medical Laboratory
51D0910134
WV
363L00000X
Nurse Practitioner
18804
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105170000
—
WV
05
—
0107822000
—
WV
05
—
0112455000
—
WV
05
—
0167011000
—
WV
05
—
1003000000
—
WV
01
—
1013971761
NPI# BRENDA WALKER,CFNP
WV
01
—
1295798361
NPI # CAROL FRAIL, MD
WV
01
—
1598744757
NPI # PENNY DIVITA,DO
WV
01
—
1912961343
NPI # JOE MATUSIC, MD
WV
01
—
1922061076
SUE ANN UPTON,MD NPI #
WV
05
—
4000022000
—
WV
Enumeration date
09/21/2006
Last updated
06/23/2011
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