Healthcare Provider Details

I. General information

NPI: 1023014362
Provider Name (Legal Business Name): KIMBERLY LYNN SKAFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MACCORKLE AVE SE STE A
CHARLESTON WV
25304-1835
US

IV. Provider business mailing address

4502 MACCORKLE AVE SE STE A
CHARLESTON WV
25304-1835
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-5500
  • Fax: 304-925-6780
Mailing address:
  • Phone: 304-925-5500
  • Fax: 304-925-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberWV13595
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: