Healthcare Provider Details

I. General information

NPI: 1659990133
Provider Name (Legal Business Name): ELLIOTT CHIARTAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ROANE ST
CHARLESTON WV
25302-2334
US

IV. Provider business mailing address

110 ROANE ST
CHARLESTON WV
25302-2334
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4297
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: