|Entity Type||Healthcare Provider|
|Active||Over 9 years ago|
|Name||SHANNON G SHANNON|
|4820 KENTUCKY ST
SOUTH CHARLESTON WV, 25309-1310, US
|4820 KENTUCKY STREET
SOUTH CHARLESTON WV, 25309-1364, US
|License State||West Virginia|
|Remove 1053539387 NPI Number|
According to our database, Crystal Bastin Md Llc NPI is 1053539387, taxonomy code is 207Q00000X and license number is 20368, license state is located at West Virginia. Crystal Bastin Md Llc physically located at 4820 Kentucky St, South Charleston WV, 25309-1310. NPI Number 1033115704 has the healthcare provider type.
1053539387 NPI number is provided on an as is basis without warranty of any kind. 1053539387 is maintained by the National Plan & Provider Enumeration System. The contents of Crystal Bastin Md Llc are for informational purposes only.