Healthcare Provider Details

I. General information

NPI: 1023144458
Provider Name (Legal Business Name): INTERNAL MEDICINE OF BLUEFIELD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 SOUTHVIEW DR SUITE 1
BLUEFIELD WV
24701-4320
US

IV. Provider business mailing address

PO BOX 99
BLUEFIELD WV
24701-0099
US

V. Phone/Fax

Practice location:
  • Phone: 304-325-8307
  • Fax: 304-323-1888
Mailing address:
  • Phone: 304-325-8307
  • Fax: 304-323-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number09514
License Number StateWV

VIII. Authorized Official

Name: DR. MARIO S CARDONA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 304-325-8307