Provider Demographics
NPI:1851552335
Name:CHARLESTON HEART SPECIALISTS PLLC
Entity Type:Organization
Organization Name:CHARLESTON HEART SPECIALISTS PLLC
Other - Org Name:IYER LEE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:BASU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-346-2284
Mailing Address - Street 1:2335 CHESTERFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1066
Mailing Address - Country:US
Mailing Address - Phone:304-346-2284
Mailing Address - Fax:304-345-7745
Practice Address - Street 1:2335 CHESTERFIELD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1066
Practice Address - Country:US
Practice Address - Phone:304-346-2284
Practice Address - Fax:304-345-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13143207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033172077OtherNPI NUMBER
WV0087274000Medicaid
WV0086281000Medicaid
1497718803OtherNPI NUMBER
G66346Medicare UPIN
WV0513046Medicare PIN
WV0942762Medicare PIN
E88023Medicare UPIN
WV0086281000Medicaid
WV0831514Medicare PIN