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General NPI Number Information
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NPI Number | 1497944607
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Entity Type | Organization
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Legal Business Name | CHARLES S. MCCLUNG SR., DO
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 226 SKYLAR DR
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City | LEWISBURG
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State | WV
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Zip | 24901-9383
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Country | US
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Telephone | 304-647-9971
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Fax | 304-647-9973
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Provider Business Mailing Address
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Address Line | PO BOX 1849
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City | LEWISBURG
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State | WV
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Zip | 24901-4849
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Country | US
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Telephone | 304-647-9971
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Fax | 304-647-9973
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. CHARLES SCOTT MCCLUNG SR.
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Credential | D.O.
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Telephone | 304-647-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1484
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License Number State | WV
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