Crystal Bastin Md Llc

NPI 1053539387 - Family Medicine - 207Q00000X

NPI Details
NPI 1053539387
Enumeration Date 04/23/2007
Last Updated 11/12/2013
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name SHANNON G SHANNON
Position OFFICE MANAGER
Phone (304) 720-0390
Fax
Practice Location
4820 KENTUCKY ST
SOUTH CHARLESTON WV, 25309-1310, US
Phone (304) 720-0390
Fax
Business Location
4820 KENTUCKY STREET
SOUTH CHARLESTON WV, 25309-1364, US
Phone (304) 720-0390
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State West Virginia
License Number 20368
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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.

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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.