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General NPI Number Information
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NPI Number | 1639231087
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Entity Type | Individual
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Provider Name | DAVID CHARLES CARLISLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 165 SCOTT AVE SUITE 100
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City | MORGANTOWN
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State | WV
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Zip | 26508-8847
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Country | US
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Telephone | 304-554-0400
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Fax | 304-554-0404
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Provider Business Mailing Address
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Address Line | 125 N 6TH ST
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City | CLARKSBURG
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State | WV
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Zip | 26301-2665
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Country | US
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Telephone | 304-624-7200
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Fax | 304-554-0404
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD436112
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | MD436112
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 20946
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 90420
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 90429
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 90429
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 20946
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License Number State | WV
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Taxonomy #8
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 20946
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License Number State | WV
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