Healthcare Provider Details

I. General information

NPI: 1356030555
Provider Name (Legal Business Name): BRIANA MARIE TABLER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SOMERSET BLVD STE 101
CHARLES TOWN WV
25414-3954
US

IV. Provider business mailing address

41 NEW THOMAS DR
CHARLES TOWN WV
25414-4822
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-2663
  • Fax:
Mailing address:
  • Phone: 304-279-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number10541
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: