Healthcare Provider Details

I. General information

NPI: 1942353719
Provider Name (Legal Business Name): FRED T. PULIDO, JR., M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 VIRGINIA ST E THIRD FLOOR
CHARLESTON WV
25301-2908
US

IV. Provider business mailing address

1213 VIRGINIA ST E THIRD FLOOR
CHARLESTON WV
25301-2908
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-5466
  • Fax:
Mailing address:
  • Phone: 304-345-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. GENIA M. FACEMYRE
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-345-5466