Healthcare Provider Details

I. General information

NPI: 1245618677
Provider Name (Legal Business Name): BECKLEY CARDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 HARPER RD
BECKLEY WV
25801-3366
US

IV. Provider business mailing address

1832 HARPER RD
BECKLEY WV
25801-3366
US

V. Phone/Fax

Practice location:
  • Phone: 681-207-7129
  • Fax: 681-207-7132
Mailing address:
  • Phone: 681-207-7129
  • Fax: 681-207-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24076
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number24136
License Number StateWV

VIII. Authorized Official

Name: DR. GANESH ASAITHAMBI
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 681-207-7129