Healthcare Provider Details

I. General information

NPI: 1699071993
Provider Name (Legal Business Name): JESSICA BETH SALANSKY MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KENTON DR SUITE 100
CHARLESTON WV
25311-1263
US

IV. Provider business mailing address

300 KENTON DR SUITE 100
CHARLESTON WV
25311-1263
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-5533
  • Fax: 304-346-5611
Mailing address:
  • Phone: 304-346-5533
  • Fax: 304-346-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24142
License Number StateWV

VIII. Authorized Official

Name: DR. JESSICA BETH SALANSKY
Title or Position: PHYISCIAN
Credential: MD
Phone: 304-346-5533