Healthcare Provider Details

I. General information

NPI: 1043228414
Provider Name (Legal Business Name): CHRISTOPHER P KOLIBASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 THREE SPRINGS DR STE 5A
WEIRTON WV
26062-3839
US

IV. Provider business mailing address

PO BOX 645532
PITTSBURGH PA
15264-5253
US

V. Phone/Fax

Practice location:
  • Phone: 740-792-4220
  • Fax: 740-275-4472
Mailing address:
  • Phone: 740-792-4220
  • Fax: 740-275-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number53275-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number53275-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35.123190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: