Healthcare Provider Details

I. General information

NPI: 1942671227
Provider Name (Legal Business Name): EDWARD W ESKEW D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MACCORKLE AVENUE, SW THSPP-PSYCHIATRY
SOUTH CHARLESTON WV
25309
US

IV. Provider business mailing address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

V. Phone/Fax

Practice location:
  • Phone: 304-306-3051
  • Fax: 304-306-3052
Mailing address:
  • Phone: 304-414-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number708
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: