Healthcare Provider Details

I. General information

NPI: 1629148432
Provider Name (Legal Business Name): CHARLES W. REYES M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 GARFIELD AVE STE 202
PARKERSBURG WV
26101-3247
US

IV. Provider business mailing address

1212 GARFIELD AVE SUITE 300
PARKERSBURG WV
26101-3247
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-3640
  • Fax: 304-865-3700
Mailing address:
  • Phone: 304-865-3600
  • Fax: 304-865-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-05-4845R
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11189
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: