Provider Type Icon

MOUNTAIN STATE MEDICAL SPECIALTIES PLLC NPI 1891892097


NPI Information

NPI: 1891892097
Provider Name: MOUNTAIN STATE MEDICAL SPECIALTIES, PLLC
Classification: Dermatology - 207N00000X
Entity Type: Organization
Address:
120 MEDICAL PARK DR
SUITE 200
BRIDGEPORT, WV
ZIP 26330
Phone: (304) 624-7200
Get Directions

MOUNTAIN STATE MEDICAL SPECIALTIES, PLLC is a dermatology in Bridgeport, WV. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. MOUNTAIN STATE MEDICAL SPECIALTIES, PLLC NPI is 1891892097. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

120 MEDICAL PARK DR
SUITE 200
BRIDGEPORT, WV
ZIP 26330-012
Phone: (304) 624-7200
Fax: (304) 554-0413

The provider's authorized official is Charles Bradley Franz .
The authorized official title is President and has the following contact phone number (304) 624-7200.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 7/18/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician AssistantNo
2363LF0000XNurse PractitionerFamilyNo
3207K00000XAllergy & ImmunologyNo
4207ND0101XDermatologyMOHS-Micrographic SurgeryNo
5207ND0900XDermatologyDermatopathologyNo
6207NS0135XDermatologyProcedural DermatologyNo
7207Q00000XFamily MedicineNo
8207R00000XInternal MedicineNo
9207RR0500XInternal MedicineRheumatologyNo
10291U00000XClinical Medical LaboratoryWEST VIRGINIANo
11207N00000XDermatologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13810004579MEDICAIDWEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.