Healthcare Provider Details

I. General information

NPI: 1104070929
Provider Name (Legal Business Name): CHARLES PRICE SCHADE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 CHESTERFIELD AVE
CHARLESTON WV
25304-1126
US

IV. Provider business mailing address

3001 CHESTERFIELD AVE
CHARLESTON WV
25304-1126
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-9864
  • Fax:
Mailing address:
  • Phone: 304-346-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number18513
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD9650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: