Organization
CHARLESTON CARDIOLOGY GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD R LILLY MD (CHAIRMAN BOARD OF DIRECTORS)
(304) 342-1184
Entity
Organization
Contact information
Practice address
3100 MACCORKLE AVE, SUITE 709, CHARLESTON, WV 25304-1223
(304) 342-1184
(304) 343-8487
Mailing address
3100 MACCORKLE AVE, SUITE 709, CHARLESTON, WV 25304-1223
(304) 342-1184
(304) 343-8487
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810004453
—
WV
Enumeration date
02/21/2006
Last updated
08/22/2020
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