Individual
MA THERESA CONCEPCION BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 MORRIS ST, 3 WEST ADMINISTRATION, CHARLESTON, WV 25301-1326
(304) 388-3574
(304) 388-6481
Mailing address
501 MORRIS ST, STE 357, CHARLESTON, WV 25301-1326
(304) 388-3574
(304) 388-6481
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
25853
WV
Other
Enumeration date
03/30/2011
Last updated
11/24/2015
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