Healthcare Provider Details

I. General information

NPI: 1235716366
Provider Name (Legal Business Name): CHARLES EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

PO BOX 9149
MORGANTOWN WV
26506-9149
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-2436
  • Fax: 304-293-6702
Mailing address:
  • Phone: 304-293-2436
  • Fax: 304-293-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number75766
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number32947
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: