Healthcare Provider Details

I. General information

NPI: 1720108582
Provider Name (Legal Business Name): CHARLES E PORTERFIELD DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 ROBERT C BYRD DRIVE
BECKLEY WV
25801
US

IV. Provider business mailing address

PO BOX 1307
BECKLEY WV
25802-1307
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-5710
  • Fax: 304-255-5702
Mailing address:
  • Phone: 304-255-5710
  • Fax: 304-255-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1084
License Number StateWV

VIII. Authorized Official

Name: CHARLES E PORTERFIELD
Title or Position: PHYSICIAN
Credential: DO
Phone: 304-255-5710