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General NPI Number Information
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NPI Number | 1548818040
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Entity Type | Individual
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Provider Name | CHARLENE MARIE LACOSTE PA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR
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City | MORGANTOWN
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State | WV
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Zip | 26506-1200
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Country | US
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Telephone | 855-988-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2247 STATE ROUTE 18
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City | ALIQUIPPA
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State | PA
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Zip | 15001-9761
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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