Provider Demographics
NPI:1952483802
Name:CHARLESTON GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:CHARLESTON GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-342-0821
Mailing Address - Street 1:401 DIVISION ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1455
Mailing Address - Country:US
Mailing Address - Phone:304-342-0821
Mailing Address - Fax:304-345-6679
Practice Address - Street 1:401 DIVISION ST STE 205
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-342-0821
Practice Address - Fax:304-345-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0008437000Medicare ID - Type Unspecified
9265481Medicare ID - Type Unspecified