Provider Demographics
NPI:1669508438
Name:KANAWHA VALLEY HEART SPECIALISTS
Entity type:Organization
Organization Name:KANAWHA VALLEY HEART SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GHARIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-205-7992
Mailing Address - Street 1:4610 KANAWHA AVE, SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1320
Mailing Address - Country:US
Mailing Address - Phone:304-205-7992
Mailing Address - Fax:304-205-7739
Practice Address - Street 1:4610 KANAWHA AVE, SW
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1320
Practice Address - Country:US
Practice Address - Phone:304-205-7992
Practice Address - Fax:304-205-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11014209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty