Provider Demographics
NPI:1477940922
Name:GOLDEN, MICHAEL LESLIE III (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LESLIE
Last Name:GOLDEN
Suffix:III
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SOMERSET BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3953
Mailing Address - Country:US
Mailing Address - Phone:304-725-2663
Mailing Address - Fax:
Practice Address - Street 1:912 SOMERSET BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-725-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210048207X00000X
UT11725386-1205207XX0005X
WV30403207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery