Basic Information
| Provider Information | |||||||||
| NPI: | 1801947684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KESSEL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263309006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813421000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 327 MEDICAL PARK DR | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263309006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813421000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 10544 | WV | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0063635000 | 05 | WV | MEDICAID |