Healthcare Provider Details

I. General information

NPI: 1124162128
Provider Name (Legal Business Name): CHARLES ABRAHAM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 6TH AVE
HUNTINGTON WV
25701-2311
US

IV. Provider business mailing address

1231 6TH AVE
HUNTINGTON WV
25701-2311
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1122
  • Fax:
Mailing address:
  • Phone: 304-522-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberWV09147
License Number StateWV

VIII. Authorized Official

Name: DR. CHARLES ABRAHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 304-522-1122