Healthcare Provider Details

I. General information

NPI: 1649659517
Provider Name (Legal Business Name): KRISTEN ELAINE BABIAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE ROOM 58
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

28 BRIDLEWOOD RD
CHARLESTON WV
25314-2101
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7170
  • Fax:
Mailing address:
  • Phone: 304-395-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3431
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: