Organization
CENTRAL WV DERM ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GEORGIA DAWN DANIEL CRNP (CHIEF OPERATING OFFICER)
(304) 842-3494
Entity
Organization
Contact information
Practice address
170 THOMPSON DR, SUITE 200, BRIDGEPORT, WV 26330-2608
(304) 842-3494
(304) 842-2339
Mailing address
PO BOX 4550, BRIDGEPORT, WV 26330-4550
(304) 842-3494
(304) 842-2339
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019121420001
—
PA
05
—
2624959
—
OH
05
—
2624968
—
OH
05
—
3810003851
—
WV
Enumeration date
08/31/2006
Last updated
09/10/2009
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