Healthcare Provider Details

I. General information

NPI: 1700246220
Provider Name (Legal Business Name): BECKLEY CARDIOVASCULAR SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 KANAWHA AVE SW SUITE 200
SOUTH CHARLESTON WV
25309-1367
US

IV. Provider business mailing address

4610 KANAWHA AVE SW SUITE 200
SOUTH CHARLESTON WV
25309-1367
US

V. Phone/Fax

Practice location:
  • Phone: 304-205-7992
  • Fax: 304-205-7739
Mailing address:
  • Phone: 304-205-7992
  • Fax: 304-205-7739

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: ELIE GHARIB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-205-7992