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General NPI Number Information
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NPI Number | 1093988545
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Entity Type | Organization
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Legal Business Name | GEOFFREY R. COUSINS, MD, PLLC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 2345 CHESTERFIELD AVE SUITE 304
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City | CHARLESTON
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State | WV
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Zip | 25304-1062
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Country | US
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Telephone | 304-720-2244
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Fax | 304-720-2245
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Provider Business Mailing Address
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Address Line | PO BOX 4695
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City | CHARLESTON
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State | WV
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Zip | 25364-4695
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Country | US
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Telephone | 304-720-2244
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Fax | 304-720-2245
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Authorized Official
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Title or Position | OWNER
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Name | GEOFFREY R COUSINS
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Credential | MD
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Telephone | 304-720-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21957
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License Number State | WV
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