Healthcare Provider Details

I. General information

NPI: 1437257441
Provider Name (Legal Business Name): CHARBROOK MEDICO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CHERRY ST STE. 202
BLUEFIELD WV
24701-3338
US

IV. Provider business mailing address

510 CHERRY ST STE. 202
BLUEFIELD WV
24701-3338
US

V. Phone/Fax

Practice location:
  • Phone: 304-325-3666
  • Fax: 304-327-2497
Mailing address:
  • Phone: 304-325-3666
  • Fax: 304-327-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number11940
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number08251
License Number StateWV

VIII. Authorized Official

Name: DR. JOHN BROOKINS TAYLOR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-325-3666