Healthcare Provider Details

I. General information

NPI: 1093771982
Provider Name (Legal Business Name): ASSOCIATED CARDIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CHESTERFIELD AVE
CHARLESTON WV
25304-1125
US

IV. Provider business mailing address

2930 CHESTERFIELD AVE
CHARLESTON WV
25304-1125
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-9923
  • Fax: 304-343-9925
Mailing address:
  • Phone: 304-343-9923
  • Fax: 304-343-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15412
License Number StateWV

VIII. Authorized Official

Name: DR. JAMES JARRETT PETTIT II
Title or Position: PARTNER
Credential: MD
Phone: 304-343-9923