| NPI | 1114491792 |
|---|---|
| Doing Business As | MOUNTAINSTATE INFECTIOUS DISEASE |
| Entity Type | Organization |
| Authorized Contact | DINO DELAPORTAS Md/Owner 304-641-1822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2019-01-16 |