Healthcare Provider Details

I. General information

NPI: 1851514830
Provider Name (Legal Business Name): WEST VIRGINIA GYNECOLOGIC ONCOLOGY ASSOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COURTNEY DR
CHARLESTON WV
25304-2696
US

IV. Provider business mailing address

1 COURTNEY DR
CHARLESTON WV
25304-2696
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-4200
  • Fax: 304-925-0484
Mailing address:
  • Phone: 304-925-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number18239
License Number StateWV

VIII. Authorized Official

Name: MICHAEL A SCHIANO
Title or Position: OWNER
Credential: MD
Phone: 304-925-4200