Healthcare Provider Details

I. General information

NPI: 1669452637
Provider Name (Legal Business Name): CHARLENE FRANCES HORAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 MASON DIXON HWY
MAIDSVILLE WV
26541-8152
US

IV. Provider business mailing address

1929 MASON DIXON HIGHWAY
CORE WV
26541
US

V. Phone/Fax

Practice location:
  • Phone: 304-879-5020
  • Fax: 304-879-4105
Mailing address:
  • Phone: 304-879-8521
  • Fax: 304-879-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12054
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number12054
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: