Healthcare Provider Details

I. General information

NPI: 1912044389
Provider Name (Legal Business Name): CHARLESTON HEART SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 CHESTERFIELD AVE SUITE 200
CHARLESTON WV
25304-1062
US

IV. Provider business mailing address

2345 CHESTERFIELD AVE SUITE 200
CHARLESTON WV
25304-1062
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-2284
  • Fax: 304-345-7745
Mailing address:
  • Phone: 304-346-2284
  • Fax: 304-345-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA BETH LILLY
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 304-346-2284