Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 27487 | WV |
NPI | 1114361961 |
---|---|
Provider Name | Dr. Charles Matthew Justice |
First Address | Charleston, WV 25304-1210 |
Second Address | Charleston, WV 25304-1210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 12/01/2021 |