Organization
CHARLESTON CARDIOVASCULAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR HALLAK MD (OWNER)
(304) 792-6275
Entity
Organization
Contact information
Practice address
331 LAIDLEY ST, SUITE 402, CHARLESTON, WV 25301-1619
(304) 792-6275
Mailing address
331 LAIDLEY ST, SUITE 402, CHARLESTON, WV 25301-1619
(304) 792-6275
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
19813
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000241000
—
WV
Enumeration date
11/04/2007
Last updated
11/04/2007
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