MEDICARE: DR. CHRISTOPHER P KOLIBASH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	53275-20	WI
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	53275-20	WI
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	35.123190	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35123190	OTHER	OH	MEDICAL LICENSE
2	MD428014	OTHER	PA	MEDICAL LICENSE
3	25751	OTHER	WV	MEDICAL LICENSE

General Provider Information

NPI Number	:	1043228414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER P KOLIBASH MD

Provider Business Mailing Address
First Line	:	PO BOX 645532
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15264-5253
Country	:	US
Telephone Number	:	740-792-4220
Fax Number	:	740-275-4472

Provider Business Practice Location Address
First Line	:	243 THREE SPRINGS DR STE 5A
Second Line	:
City	:	WEIRTON
State	:	WV
Zip	:	26062-3839
Country	:	US
Telephone Number	:	740-792-4220
Fax Number	:	740-275-4472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	02/29/2024

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Directions to “ DR. CHRISTOPHER P KOLIBASH MD” Practice Location

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