Basic Information
| Provider Information | |||||||||
| NPI: | 1215311444 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLESTON INTERNAL MEDICINE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047202345 | ||||||||
| FaxNumber: | 3047202347 | ||||||||
| Practice Location | |||||||||
| Address1: | 3701 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047202345 | ||||||||
| FaxNumber: | 3047202347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2015 | ||||||||
| LastUpdateDate: | 07/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3047202345 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN76968-NP-C | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.