Provider Demographics
NPI:1780112557
Name:JAVINS, MARK EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:JAVINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 MACCORKLE AVENUE, SW
Mailing Address - Street 2:THS PHYSICIAN PARTNERS, INC.-ADMIN OFC
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:
Practice Address - Street 1:610 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1251
Practice Address - Country:US
Practice Address - Phone:304-767-7790
Practice Address - Fax:304-767-7566
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV778363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant