Healthcare Provider Details

I. General information

NPI: 1164545000
Provider Name (Legal Business Name): MICHAEL ELMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 700
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

3110 MACCORKLE AVE SE
CHARLESTON WV
25304-1210
US

V. Phone/Fax

Practice location:
  • Phone: 304-556-3810
  • Fax: 304-347-1397
Mailing address:
  • Phone: 304-347-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number23506
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: