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General NPI Number Information
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NPI Number | 1710128541
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Entity Type | Organization
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Legal Business Name | CHARLESTON DIABETES & ENDOCRINE CONSULTANTS, PLLC
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 3100 MACCORKLE AVE SUITE 810
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City | CHARLESTON
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State | WV
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Zip | 25304-1223
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Country | US
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Telephone | 304-720-4422
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Fax | 304-720-4421
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Provider Business Mailing Address
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Address Line | 3100 MACCORKLE AVE SUITE 810
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City | CHARLESTON
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State | WV
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Zip | 25304-1223
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Country | US
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Telephone | 304-720-4422
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Fax | 304-720-4421
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Authorized Official
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Title or Position | MD/OWNER
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Name | PRASUNA JAMI
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Credential | MD
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Telephone | 304-720-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 21072
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License Number State | WV
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