Individual
JEFFERY F ADDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
331 LAIDLEY ST STE 307, CHARLESTON, WV 25301-1605
(304) 208-1414
(304) 344-2108
Mailing address
331 LAIDLEY ST STE 307, CHARLESTON, WV 25301-1605
(304) 208-1414
(304) 344-2108
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
15775
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10010042
BRICKSTREET
WV
01
—
197254861
PEIA
—
01
—
1972548618
AETNA
—
01
—
2496080
OHIO JOB & FAMILY SERVICES
—
05
—
2496080
—
OH
01
—
271503047
MSBCBS
WV
01
—
271503047
TRICARE
—
05
—
3810000347
—
WV
01
—
614835100
FEDERAL WORKERS COMP
—
01
—
6608290
CIGNA
—
Enumeration date
06/17/2006
Last updated
05/26/2010
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