Individual provider · NPI-1

Dr. Crystal H Bastin, M.D.

Family Medicine · South Charleston, WV

NPI number1962453191
StatusActive
Last updated in NPPESJan 13, 2022

Details

NPI
1962453191
Entity type
Individual (NPI-1)
Name
Dr. Crystal H Bastin
Credential
M.D.
Sex
Female
Sole proprietor
No
Enumeration date
May 12, 2006
Certification date
Jan 13, 2022
Last updated
Jan 13, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine20368WVYes

Other names

  • Crystal Lea Heatherman (Former Name)

Practice location

4820 Kentucky St
South Charleston, WV 25309

Phone 304-720-0390 · Fax 304-720-0391

Mailing address

4605 Maccorkle Ave Sw
Ths Physician Partners, INC. - Admin Ofc
South Charleston, WV 25309-1311

Phone 304-414-4800 · Fax 304-414-4801

Other practice locations

4605 Maccorkle Ave Sw
South Charleston, WV 25309-1311

Phone 304-414-4800

11924 Winfield Rd
Winfield, WV 25213-7913

Phone 304-306-3060 · Fax 304-306-3061

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