Provider Demographics
NPI:1386724029
Name:ADVANCED CARDIO-VASCULAR SERVICES, PLLC
Entity type:Organization
Organization Name:ADVANCED CARDIO-VASCULAR SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GANPAT
Authorized Official - Middle Name:GOPALJI
Authorized Official - Last Name:THAKKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-345-5460
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 902
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-345-5460
Mailing Address - Fax:304-345-5575
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 902
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-345-5460
Practice Address - Fax:304-345-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12498207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9282411Medicare ID - Type Unspecified