Individual
SCOTT DAVID ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3100 MACCORKLE AVE SE, SUITE 806, CHARLESTON, WV 25304-1223
(304) 344-9480
(304) 344-9481
Mailing address
4619 KANAWHA AVE SW, SUITE 806, SOUTH CHARLESTON, WV 25309-1319
(304) 400-4545
(304) 400-4546
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01317
WV
Other
Enumeration date
11/05/2007
Last updated
01/24/2017
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