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General NPI Number Information
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NPI Number | 1487927141
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Entity Type | Organization
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Legal Business Name | MICHAEL FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 2055 VALLEY ROAD
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City | BERKELEY SPRINGS
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State | WV
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Zip | 25411
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Country | US
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Telephone | 304-258-8824
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1111
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City | BERKELEY SPRINGS
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State | WV
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Zip | 25411-3111
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Country | US
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Telephone | 304-258-8824
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. AMANDA G MICHAEL
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Credential | D.O.
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Telephone | 304-258-8824
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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 | 2583
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License Number State | WV
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