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General NPI Number Information
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NPI Number | 1154436004
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Entity Type | Organization
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Legal Business Name | MIDTOWNE FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 403 12TH STREET EXT
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City | PRINCETON
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State | WV
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Zip | 24740-2300
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Country | US
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Telephone | 304-431-9998
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Fax | 304-425-0782
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Provider Business Mailing Address
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Address Line | PO BOX 1030
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City | PRINCETON
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State | WV
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Zip | 24740-1030
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Country | US
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Telephone | 304-431-7100
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Fax | 304-431-7112
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | PAMELA P. FAULKNER
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Credential | DO
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Telephone | 304-431-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1040
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License Number State | WV
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