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BANDAK PLASTIC SURGERY PLLC
NPI 1457564213
Surgery - Plastic and Reconstructive Surgery in Charleston, WV

Active since May 08, 2007CLIA 51D2216430 · Waiver
4920 MACCORKLE AVE SE, CHARLESTON, WV 25304(304) 925-4665(304) 925-4666 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Bandak Plastic Surgery Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BANDAK PLASTIC SURGERY PLLC (NPI 1457564213) is a healthcare organization registered as a plastic and reconstructive surgery in Charleston, West Virginia and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through March 11, 2027 and lists Abdalla Z Bandak, Owner, as its authorized official.

NPPES Registry Identity

NPI1457564213
Entity TypeOrganization
Primary Taxonomy2086S0122X
Legal Business NameBANDAK PLASTIC SURGERY PLLC
Location Address4920 MACCORKLE AVE SECharleston, WV 25304-2052
Mailing Address4920 Maccorkle Ave SeCharleston, WV 25304-2052 · (304) 925-4665 · Fax (304) 925-4666
Phone(304) 925-4665
Fax(304) 925-4666
Organization SubpartNo
Authorized OfficialAbdalla Z BandakOwner · (304) 925-4665
Enumeration DateMay 8, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1457564213 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in WV · 21839
Definition
A surgeon who specializes in plastic and reconstructive surgery.
4920 MACCORKLE AVE SE, Charleston, WV 25304
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 51D2216430

Bandak Plastic Surgery · Charleston, WV
Active · expires Mar 11, 2027
CLIA Number51D2216430
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateMarch 12, 2025
Certificate Expiration DateMarch 11, 2027
Laboratory DirectorDr. Abdalla Z. Bandak
Laboratory Phone(304) 925-4665
Laboratory LocationBandak Plastic Surgery610 50th St SE, Charleston, WV 25304
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AFIF S HABASH MD
Pediatrics (Adolescent Medicine)
4920 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 442-8117
DR. ABDALLA ZACKARIA BANDAK MD
Surgery (Plastic and Reconstructive Surgery)
4920 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 741-5510

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bandak Plastic Surgery PLLC's NPI number?

The NPI number for Bandak Plastic Surgery PLLC is 1457564213. It was assigned to this organization in the NPPES registry on May 8, 2007.

Where is Bandak Plastic Surgery PLLC located?

Bandak Plastic Surgery PLLC is located at 4920 Maccorkle Ave SE, Charleston, WV 25304. The listed phone number is (304) 925-4665.

What is Bandak Plastic Surgery PLLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Does Bandak Plastic Surgery PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 51D2216430) is associated with this NPI, valid through March 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bandak Plastic Surgery PLLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.