Organization
SOUTH CHARLESTON PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER FISHER (OFFICE MANAGER)
(304) 982-7334
Entity
Organization
Contact information
Practice address
830 PENNSYLVANIA AVENUE, SUITE 110, CHARLESTON, WV 25302
(304) 982-7031
(304) 766-9450
Mailing address
830 PENNSYLVANIA AVENUE, SUITE 110, CHARLESTON, WV 25302
(304) 982-7031
(304) 766-9450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4005199000
—
WV
Enumeration date
10/19/2006
Last updated
07/21/2022
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