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Individual

CHARLES RONALD SMALLING JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2131 E STATE ST, ATHENS, OH 45701-2138
(740) 589-3100
(740) 566-4049
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 589-3100
(740) 566-4049

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01055546A
IN
207N00000X
Dermatology Physician
27830
SC
207N00000X
Dermatology Physician
Primary
35.088883
OH
207ND0900X
Dermatopathology Physician
27830
SC
207NS0135X
Procedural Dermatology Physician
01055546A
IN
207NS0135X
Procedural Dermatology Physician
27830
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000204802
OH MEDICAID UNISON
OH
01
2723815
OH MEDICAID MOLINA
OH
05
2723815
OH
01
310917085159
OH MEDICAID CARESOURCE
OH
05
3810007810
WV
01
P00362716
RAILROAD MEDICARE
OH
Enumeration date
11/23/2005
Last updated
02/09/2015
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