Pediatric Gastroenterology of Charleston, PLLC

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

24418 Issued in WV

Legal business name

PEDIATRIC GASTROENTEROLOGY OF CHARLESTON, PLLC

Practice address

428 Division St
Suite 3a
South Charleston, WV 25309-1469

Phone

(304) 400-4626

NPI assigned

Jul 5, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ahmed Dahshan, M.D.

Title

Physician/Owner

Phone

(304) 400-4626

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1609216605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 DIVISION ST",
            "address_2": "SUITE 3A",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091469",
            "telephone_number": "304-400-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 DIVISION ST",
            "address_2": "SUITE 3A",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091469",
            "telephone_number": "304-400-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC GASTROENTEROLOGY OF CHARLESTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-05",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "DAHSHAN",
        "authorized_official_first_name": "AHMED",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "304-400-4626",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "WV",
            "license": "24418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "381002088",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Gastroenterology Physician in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Pediatric Gastroenterology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.