NPI 1174604409

South Charleston Dermatology PLLC

Organisation Dermatology Physician South Charleston, WV

Practice location

Address: 4815 Kanawha Ave SW, South Charleston, WV 25309-1207
Phone: (304) 768-4567
Fax: (304) 768-2277

Authorised official

Name: Michelle Leigh Endicott
Title: Owner/Physician
Phone: (304) 768-4567

Registered specialties

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X Licence 2097 (WV)

Other Dermatology providers in West Virginia →

Registry record

NPI: 1174604409
Entity type: Organization
NPI issued: 17 Oct 2006
Record last updated: 12 Dec 2011

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.