Healthcare Provider Details

I. General information

NPI: 1235633769
Provider Name (Legal Business Name): JUSTIN HARVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 W MAIN ST
SALEM VA
24153-3610
US

IV. Provider business mailing address

1337 RIDDLE AVE APT 3
MORGANTOWN WV
26505-2879
US

V. Phone/Fax

Practice location:
  • Phone: 540-855-5100
  • Fax: 403-424-3735
Mailing address:
  • Phone: 394-646-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101274250
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31147
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: