1184958472 NPI number — DERMATOLOGY CENTER FOR SKIN HEALTH, PLLC

Table of content: MATTHEW JAMES HARTWELL MD (NPI 1275074619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184958472 NPI number — DERMATOLOGY CENTER FOR SKIN HEALTH, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGY CENTER FOR SKIN HEALTH, PLLC
Provider Last Name:
Provider First Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1184958472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 SUNCREST TOWN CENTRE DR
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26505-1872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-598-3888
Provider Business Mailing Address Fax Number:
304-598-0564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SUNCREST TOWN CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-1872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-598-3888
Provider Business Practice Location Address Fax Number:
304-598-0564
Provider Enumeration Date:
09/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WAYBRIGHT
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
ELISABETH
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
304-225-2236

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  54321 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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