Healthcare Provider Details

I. General information

NPI: 1306907233
Provider Name (Legal Business Name): PROFESSIONAL CARDIOTHORACIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE SUITE 811
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE SUITE 811
CHARLESTON WV
25304-1223
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-1875
  • Fax: 304-720-1878
Mailing address:
  • Phone: 304-720-1875
  • Fax: 304-720-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number001
License Number StateWV

VIII. Authorized Official

Name: DR. MOHAMMAD SALIM RATNANI
Title or Position: OWNER
Credential: MD
Phone: 304-720-1875