Organization
SOUTH CHARLESTON DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE LEIGH ENDICOTT DO (OWNER/PHYSICIAN)
(304) 768-4567
Entity
Organization
Contact information
Practice address
4815 KANAWHA AVE SW, SOUTH CHARLESTON, WV 25309-1207
(304) 768-4567
(304) 768-2277
Mailing address
4815 KANAWHA AVE SW, SOUTH CHARLESTON, WV 25309-1207
(304) 768-4567
(304) 768-2277
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2097
WV
Other
Enumeration date
10/17/2006
Last updated
12/12/2011
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