Healthcare Provider Details

I. General information

NPI: 1477757540
Provider Name (Legal Business Name): CHARLES EDWARD FRANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 LOCUST AVE SUITE 102
FAIRMONT WV
26554-1332
US

IV. Provider business mailing address

1708 LOCUST AVE SUITE 102
FAIRMONT WV
26554-1332
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-5799
  • Fax: 304-366-0346
Mailing address:
  • Phone: 304-363-5799
  • Fax: 304-366-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number18357
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: