NPI 1962453191 · live from the CMS NPI Registry
Crystal H Bastin, M.D.
Family Medicine in South Charleston, WV. National Provider Identifier 1962453191, active.
NPI record
| NPI | 1962453191 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 4820 Kentucky St, South Charleston, WV 25309 |
| Practice phone | 304-720-0390 |
| Mailing address | 4605 Maccorkle Ave Sw, Ths Physician Partners, INC. - Admin Ofc, South Charleston, WV 25309 |
| Enumerated | May 12, 2006 |
| Last updated | January 13, 2022 |
| Sole proprietor | No |
| Other names | Crystal Heatherman |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine primary | 207Q00000X | 20368 (WV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.