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NPI Code Detail

MEDICARE: CHARLES BUKOVINSKY MD

MEDICARE: CHARLES BUKOVINSKY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician15584WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000434450OTHERBLUE CROSS BLUE SHIELD
300786626OTHERWVRR

General Provider Information

NPI Number : 1366546947
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES BUKOVINSKY MD
Provider Business Mailing Address
First Line : 97 GREAT TEAYS BLVD
Second Line : SUITE 6
City : SCOTT DEPOT
State : WV
Zip : 25560-9815
Country : US
Telephone Number : 304-757-6999
Fax Number : 304-757-3252
Provider Business Practice Location Address
First Line : 97 GREAT TEAYS BLVD
Second Line : SUITE 6
City : SCOTT DEPOT
State : WV
Zip : 25560-9815
Country : US
Telephone Number : 304-757-6999
Fax Number : 304-757-3252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2006
Last Update Date : 11/15/2018

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Directions to “ CHARLES BUKOVINSKY MD” Practice Location

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