MEDICARE: JOSEPH LAWRENCE WONSETTLER PA-C

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	363AM0700X	Medical Physician Assistant	1756	WV

General Provider Information

NPI Number	:	1386084507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH LAWRENCE WONSETTLER PA-C

Provider Business Mailing Address
First Line	:	3412 STAUNTON AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1327
Country	:	US
Telephone Number	:	304-388-6004
Fax Number	:	304-388-3360

Provider Business Practice Location Address
First Line	:	3412 STAUNTON AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1327
Country	:	US
Telephone Number	:	304-388-6004
Fax Number	:	304-388-3360

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

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	10/09/2017

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