Organization
UROLOGIC SURGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ALLAN LIGHT (OFFICE ADMINISTRATOR)
(304) 925-8521
Entity
Organization
Contact information
Practice address
11 COURTNEY DR, CHARLESTON, WV 25304-2699
(304) 925-8521
(304) 925-8523
Mailing address
11 COURTNEY DR, CHARLESTON, WV 25304-2699
(304) 925-8521
(304) 925-8523
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/16/2007
Last updated
08/22/2020
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