Healthcare Provider Details

I. General information

NPI: 1548722051
Provider Name (Legal Business Name): EDWARD CHARLES TOBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE FL 4
CHARLESTON WV
25304-1297
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 902
CHARLESTON WV
25304-1234
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-6355
  • Fax: 304-388-6009
Mailing address:
  • Phone: 304-388-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number37093
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: