Organization
MARTINSBURG INTERNAL MEDICINE ASSOC INC
Active
Other names
Martinsburg Internal Medicine Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSE B JALAZO MD (PRESIDENT)
(304) 263-0913
Entity
Organization
Contact information
Practice address
1002 SUSHRUTA DRIVE, MARTINSBURG, WV 25401
(304) 263-0913
(304) 267-2917
Mailing address
1002 SUSHRUTA DRIVE, MARTINSBURG, WV 25401
(304) 263-0913
(304) 267-2917
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008030001
—
WV
Enumeration date
12/13/2006
Last updated
08/22/2020
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