Healthcare Provider Details

I. General information

NPI: 1083889109
Provider Name (Legal Business Name): CHAFIK ASSAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CAPITOL ST
CHARLESTON WV
25301-1204
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 900
CHARLESTON WV
25304-1223
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-8822
  • Fax: 304-720-8826
Mailing address:
  • Phone: 304-388-5880
  • Fax: 304-388-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMT 187562
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number24077
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: