| |
201 Augustine Ave, Charles Town, WV 25414-4431 | |
(304) 725-0084 | |
(540) 722-9519 |
Full Name | |
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Type | Facility |
Speciality | Podiatrist |
Location | 201 Augustine Ave, Charles Town, West Virginia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1376573089 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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213E00000X | Podiatrist | 000223 (West Virginia) | Primary |
Provider Name | Paul A Kushlak |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1104031731 PECOS PAC ID: 4183796840 Enrollment ID: I20100204000442 |
Provider Name | James Dodd |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1316931447 PECOS PAC ID: 9931176971 Enrollment ID: I20101117000467 |
Mailing Address | Practice Location Address |
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Po Box 68, Ranson, WV 25438-0068 Ph: (304) 725-0084 | 201 Augustine Ave, Charles Town, WV 25414-4431 Ph: (304) 725-0084 |
West Virginia University Medical Corporation Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 912 Somerset Blvd Ste 101, Charles Town, WV 25414 Phone: 304-725-2663 Fax: 304-724-0053 |