Organization
AGNES A ENRICO-SIMON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AGNES A ENRICO-SIMON MD (PHYSICIAN)
(304) 675-6817
Entity
Organization
Contact information
Practice address
2415 JACKSON AVE, PT PLEASANT, WV 25550-2042
(304) 675-6090
(304) 675-5893
Mailing address
2415 JACKSON AVE, PT PLEASANT, WV 25550-2042
(304) 675-6090
(304) 675-5893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3002914000
—
WV
Enumeration date
06/05/2007
Last updated
08/22/2020
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