| NPI | 1427563238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYAM JAFARY RANA Physician Assistant 304-222-5817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2023-03-24 |