OrganizationActive
Mountain State Medical Specialties, PLLC
NPI 1891892097 · Dermatology Physician · Bridgeport, WV
Provider details
- NPI number
- 1891892097
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Eugene Kirkland, Cmo(513) 701-5526
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Allergy & Immunology Physician207K00000X
Allopathic & Osteopathic Physicians
- MOHS-Micrographic Surgery Physician207ND0101X
Allopathic & Osteopathic Physicians
- Dermatopathology Physician207ND0900X
Allopathic & Osteopathic Physicians
- Procedural Dermatology Physician207NS0135X
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- Internal Medicine Physician207R00000X
Practice location
120 Medical Park Dr
Suite 200
Bridgeport, WV 26330-9012
Phone: (304) 624-7200
Fax: (304) 554-0413
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 746750
Atlanta, GA 30374-6750
Registry dates
- Enumerated
- 2006-09-20
- Last updated
- 2025-03-14
- Certified
- 2025-03-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.