Individual
CHARLES BUKOVINSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
97 GREAT TEAYS BLVD, SUITE 6, SCOTT DEPOT, WV 25560-9815
(304) 757-6999
(304) 757-3252
Mailing address
97 GREAT TEAYS BLVD, SUITE 6, SCOTT DEPOT, WV 25560-9815
(304) 757-6999
(304) 757-3252
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15584
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000434450
BLUE CROSS BLUE SHIELD
—
05
—
0042568000
—
WV
01
—
00786626
RR
WV
Enumeration date
09/12/2006
Last updated
11/15/2018
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