Healthcare Provider Details

I. General information

NPI: 1588629166
Provider Name (Legal Business Name): STEPHEN KIRBY MILROY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MCCORKLE AVE SE STE 809
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

3100 MCCORKLE AVE SE STE 809
CHARLESTON WV
25304-1223
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-0280
  • Fax: 304-346-9727
Mailing address:
  • Phone: 304-345-0280
  • Fax: 304-346-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number09883
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: