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General NPI Number Information
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NPI Number | 1730330929
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Entity Type | Organization
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Legal Business Name | MICHELE D. STATON MD PLLC
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 2401 S KANAWHA ST SUITE 110A
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City | BECKLEY
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State | WV
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Zip | 25801-6967
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Country | US
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Telephone | 304-929-4646
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Fax | 304-929-4649
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Provider Business Mailing Address
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Address Line | 2401 S KANAWHA ST SUITE 110A
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City | BECKLEY
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State | WV
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Zip | 25801-6967
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Country | US
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Telephone | 304-929-4646
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Fax | 304-929-4649
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELE D STATON
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Credential | MD
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Telephone | 304-929-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 23359
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License Number State | WV
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