Healthcare Provider Details

I. General information

NPI: 1598786253
Provider Name (Legal Business Name): TONY C MAJESTRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS STREET STE 104
CHARLESTON WV
25301
US

IV. Provider business mailing address

415 MORRIS STREET STE 104
CHARLESTON WV
25301
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-1399
  • Fax: 304-345-7824
Mailing address:
  • Phone: 304-343-1399
  • Fax: 304-345-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number08956
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: