Healthcare Provider Details

I. General information

NPI: 1528396355
Provider Name (Legal Business Name): WEST VIRGINIA HEART & VASCULAR INSTITUTE LOGAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HOSPITAL DRIVE
LOGAN WV
25601
US

IV. Provider business mailing address

4607 MACCORKLE AVE SW SUITE 300
CHARLESTON WV
25309-1364
US

V. Phone/Fax

Practice location:
  • Phone: 304-239-8020
  • Fax: 304-239-8022
Mailing address:
  • Phone: 304-767-7780
  • Fax: 304-767-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIE GEORGE GHARIB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-767-7780