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General NPI Number Information
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NPI Number | 1962697532
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Entity Type | Organization
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Legal Business Name | UROLOGIST INC
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 600 DAVISSON RUN RD STE 201
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City | CLARKSBURG
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State | WV
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Zip | 26301-9307
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Country | US
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Telephone | 304-623-1581
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Fax |
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Provider Business Mailing Address
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Address Line | 600 DAVISSON RUN RD STE 201
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City | CLARKSBURG
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State | WV
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Zip | 26301-9307
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Country | US
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Telephone | 304-623-1581
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH CHRISTOPHER KASSIS
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Credential | M.D.
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Telephone | 304-623-1581
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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 | 12120
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License Number State | WV
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