Healthcare Provider Details

I. General information

NPI: 1720076334
Provider Name (Legal Business Name): MARK C BATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 CHESTERFIELD AVE SUITE 302
CHARLESTON WV
25304-1062
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-2039
  • Fax: 304-720-2041
Mailing address:
  • Phone: 304-720-2039
  • Fax: 304-720-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberWV15164
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberWV15164
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: