MOUNTAIN STATE MEDICAL SPECIALTIES, PLLC (NPI# 1891892097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891892097 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATE MEDICAL SPECIALTIES, PLLC |
| Practice Address |
120 Medical Park Dr Suite 200 Bridgeport WV 26330-9012 |
| Mailing Address |
125 N 6th St Clarksburg WV 26301-2665 |
| Practice Telephone | 3046247200 |
| Practice Fax Number | 3045540413 |
| Mailing Telephone | 3046247200 |
| Mailing Fax Number | 3045540413 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-07-18 |
| Authorized Official Name | DR. CHARLES BRADLEY FRANZ (PRESIDENT) |
| Authorized Official Telephone | 3046247200 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians | ||
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 291U00000X | Clinical Medical Laboratory | WV | Laboratories | |
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | 3810004579 | 05 |
| Street Address |
120 MEDICAL PARK DR SUITE 200 |
| City | BRIDGEPORT |
| State | WV |
| Zip Code | 26330-9012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073500773 | Erin Colleen Hawkins | Nurse Practitioner | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2005-09-29 |
| 1992155097 | United Hospital Center, Inc. | Family Medicine | 120 Medical Park Dr, Ste 300, Bridgeport, WV 26330-9012 | 2016-06-20 |
| 1871998047 | Angotti Family Eyecare Pllc | Optometrist | 120 Medical Park Dr, Suite 104, Bridgeport, WV 26330-9012 | 2014-10-29 |
| 1144659574 | Melissa Minigh | Pharmacist | 120 Medical Park Dr, Suite 102, Bridgeport, WV 26330-9012 | 2013-11-06 |
| 1053553131 | Sharifeh Farasat | Dermatology | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2009-04-03 |
| 1114128634 | Frank Thomas Angotti IIi | Psychiatry & Neurology | 120 Medical Park Dr, United Summit Center - Frank Angotti Md, Bridgeport, WV 26330-9012 | 2007-05-31 |
| 1962520387 | Lori Michele Angotti | Optometrist | 120 Medical Park Dr, Suite 104, Bridgeport, WV 26330-9012 | 2007-03-26 |
| 1598822207 | Stephen Fuller Fryer | Family Medicine | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2007-01-02 |
| 1619067873 | Anthony Catania Jr. | Podiatrist | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2006-10-16 |
| 1205933538 | Haeley E Harman | Family Medicine | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2006-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303036 | Gage Mackenzie Chichester | Nurse Anesthetist, Certified Registered | 2673 Medical Park Drive, Bridgeport, WV 26330 | 2020-10-12 |
| 1851914105 | Melany Langhurst | Social Worker | 64 Professional Place, Suite 102, Bridgeport, WV 26330 | 2020-05-21 |
| 1245704980 | Adam Christopher Stonestreet | Social Worker | Community Care of Bridgeport, 65 Professional Place, Bridgeport, WV 26330 | 2019-01-16 |
| 1588146658 | Bridgeport Physical Therapy Services, Inc. | Occupational Therapist | 25 Sweetbrier Lane, Suite 105, Bridgeport, WV 26330 | 2018-09-05 |
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1275049371 | Regional Eye Associates, Inc | Ophthalmology | 220 Southview Drive, Bridgeport, WV 26330 | 2017-12-27 |
| 1528586187 | Savanna Tamia Brown | Social Worker | 65 Professinal Place Suites 101,102103, Bridgeport, WV 26330 | 2017-09-05 |
| 1184079642 | Karla Kay Rinehart | Social Worker | 27 Trovato St., Suite 103, Bridgeport, WV 26330 | 2016-05-03 |
| 1396176756 | Willo Group LLC | Pharmacy | 460 E. Main Street, Bridgeport, WV 26330 | 2013-12-10 |
| 1891031878 | Sherri Michelle Dobson | Occupational Therapy Assistant | 1000 Maplewood Dr, Bridgeport, WV 26330 | 2012-12-20 |
| Find all providers in zip 26330 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679669345 | Allen George Saoud | Dermatology | 170 Thompson Dr Ste 200, Bridgeport, WV 26330-2608 | 2006-10-04 |
| 1144280637 | Kenneth Joseph Maiocco | Dermatology | 4639 Main St, Bridgeport, CT 06606-1838 | 2006-03-27 |
| 1952897704 | Integrated Dermatology of Bridgeport, Pllc | Dermatology | 4639 Main St, Bridgeport, CT 06606-1832 | 2018-07-05 |
| 1013206481 | Moss and Maiocco Md LLC | Dermatology | 4639 Main St, Bridgeport, CT 06606-1832 | 2011-04-06 |
| 1053553131 | Sharifeh Farasat | Dermatology | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2009-04-03 |
| 1487847570 | Kenneth J. Maiocco, M.d., P.C. | Dermatology | 4639 Main St, Bridgeport, CT 06606-1838 | 2007-08-22 |
| 1790842227 | Associates In Dermatology LLC | Dermatology | 4699 Main Street, Suite 212, Bridgeport, CT 06606 | 2007-01-03 |
| 1669583589 | Central Wv Derm Assoc Inc | Dermatology | 170 Thompson Dr, Suite 200, Bridgeport, WV 26330-2608 | 2006-08-31 |
| 1770691552 | Katherine Jane Pesce | Dermatology | 4699 Main St, Suite 212, Bridgeport, CT 06606 | 2006-08-29 |
| 1548378813 | Joseph Raymond Pesce | Dermatology | 4699 Main St, Suite 212, Bridgeport, CT 06606 | 2006-08-28 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 26330 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.