Organization
CENTER FOR DERMATOLOGY & SKIN CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY T. LAGOS DO (PRESIDENT)
(304) 766-9136
Entity
Organization
Contact information
Practice address
607 CHESTNUT STREET, SOUTH CHARLESTON, WV 25309-1205
(304) 766-9136
(304) 766-9139
Mailing address
607 CHESTNUT STREET, SOUTH CHARLESTON, WV 25309-1205
(304) 766-9136
(304) 766-9139
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1300
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0043648000
—
WV
Enumeration date
10/23/2006
Last updated
01/27/2011
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