Provider Demographics
NPI:1588658199
Name:CARDIOVASCULAR CONSULTANTS PLLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS PLLC
Other - Org Name:PUTNAM CARDIOLOGY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:YASER
Authorized Official - Last Name:HAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-757-4694
Mailing Address - Street 1:1211 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8707
Mailing Address - Country:US
Mailing Address - Phone:304-757-4694
Mailing Address - Fax:304-757-4695
Practice Address - Street 1:1211 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8707
Practice Address - Country:US
Practice Address - Phone:304-757-4694
Practice Address - Fax:304-757-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV019575207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9303461Medicare ID - Type Unspecified