Basic Information
| Provider Information | |||||||||
| NPI: | 1760598403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIANG | ||||||||
| FirstName: | MYRA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 PENNSYLVANIA AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881541 | ||||||||
| FaxNumber: | 3043881577 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 PENNSYLVANIA AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881541 | ||||||||
| FaxNumber: | 3043881577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | 15497 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
No ID Information.