Healthcare Provider Details

I. General information

NPI: 1821338047
Provider Name (Legal Business Name): ABC PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE. 200
CHARLESTON WV
25302-3302
US

IV. Provider business mailing address

830 PENNSYLVANIA AVE STE. 200
CHARLESTON WV
25302-3302
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2709
  • Fax: 304-344-1755
Mailing address:
  • Phone: 304-388-2709
  • Fax: 304-344-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number2474
License Number StateWV

VIII. Authorized Official

Name: MELISSA DAY
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-388-2709