MEDICARE: DR. JAMES NAMSUPAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	23919	WV
2	207Q00000X	Family Medicine Physician	23919	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043486145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES NAMSUPAK M.D.

Provider Business Mailing Address
First Line	:	401 GUFFEY ST
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-4029
Country	:	US
Telephone Number	:	304-363-2500
Fax Number	:	304-363-0263

Provider Business Practice Location Address
First Line	:	401 GUFFEY ST
Second Line	:	JOHN MANCHIN SR. HEALTH CARE CENTER
City	:	FAIRMONT
State	:	WV
Zip	:	26554-4029
Country	:	US
Telephone Number	:	304-363-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	09/16/2013

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