Basic Information
| Provider Information | |||||||||
| NPI: | 1639339062 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHARLESTON HEART SPECIALISTS, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEART IMAGING | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2335 CHESTERFIELD AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043462284 | ||||||||
| FaxNumber: | 3043466590 | ||||||||
| Practice Location | |||||||||
| Address1: | 2335 CHESTERFIELD AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043462284 | ||||||||
| FaxNumber: | 3043466590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | BASU | ||||||||
| AuthorizedOfficialFirstName: | DILIP | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3043462284 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 13143 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 9299784 | 01 | MEDICARE GROUP | OTHER |