Healthcare Provider Details

I. General information

NPI: 1225132681
Provider Name (Legal Business Name): LEE ANN SKAFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 MACCORKLE AVE SE
CHARLESTON WV
25304
US

IV. Provider business mailing address

4922 MACCORKLE AVE SE
CHARLESTON WV
25304
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-0923
  • Fax: 304-925-0960
Mailing address:
  • Phone: 304-925-0923
  • Fax: 304-925-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number14717
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: