Provider Demographics
NPI:1851439202
Name:CHARLESTON MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CHARLESTON MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-414-2070
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25326-1685
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-345-7320
Practice Address - Street 1:331 LAIDLEY ST
Practice Address - Street 2:SUITE 507
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1619
Practice Address - Country:US
Practice Address - Phone:304-720-1963
Practice Address - Fax:304-720-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1071392OtherBRICKSTREET GROUP
WV2154761OtherOHIO MEDICAID
WV3810008403Medicaid
WV9367401Medicare PIN