NPI 1053539387

Crystal Bastin MD LLC

Organisation Family Medicine Physician South Charleston, WV

Practice location

Address: 4820 Kentucky St, South Charleston, WV 25309-1310
Phone: (304) 720-0390
Mailing address: 4820 Kentucky Street, South Charleston, WV 25309-1364

Authorised official

Name: Shannon G Davis
Title: Office Manager
Phone: (304) 720-0390

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X Licence 20368 (WV)

Other Family Medicine providers in West Virginia →

Registry record

NPI: 1053539387
Entity type: Organization
NPI issued: 23 Apr 2007
Record last updated: 12 Nov 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.