Healthcare Provider Details

I. General information

NPI: 1962756437
Provider Name (Legal Business Name): SARAH M. NEASE, M.D., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 MACCORKLE AVE SE
CHARLESTON WV
25304-2503
US

IV. Provider business mailing address

4315 MACCORKLE AVE SE
CHARLESTON WV
25304-2503
US

V. Phone/Fax

Practice location:
  • Phone: 304-926-8080
  • Fax: 304-926-8083
Mailing address:
  • Phone: 304-926-8080
  • Fax: 304-926-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16598
License Number StateWV

VIII. Authorized Official

Name: DR. SARAH M. NEASE
Title or Position: M.D.
Credential: M.D.
Phone: 304-926-8080