Individual
DR. CHARLES FERNANDEZ CHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
936 SHARPE HOSPITAL RD, WILLIAM SHARPE JR. HOSPITAL, WESTON, WV 26452-8550
(304) 269-1210
(304) 269-0502
Mailing address
936 SHARPE HOSPITAL RD, WILLIAM SHARPE JR. HOSPITAL, WESTON, WV 26452-8550
(304) 269-1210
(304) 269-0502
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
11547
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054223000
—
WV
01
—
WV0497A
MEDICARE PTAN
WV
Enumeration date
03/10/2007
Last updated
04/23/2012
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