Individual
CHARLES HENRY STAAB III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 MEDICAL PARK, SUITE 223, WHEELING, WV 26003-6391
(304) 242-3300
(304) 242-8964
Mailing address
30 MEDICAL PARK, SUITE 223, WHEELING, WV 26003-6391
(304) 242-3300
(304) 242-8964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11194
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111925000
—
WV
05
—
0361111
—
OH
01
—
11194C
HEALTH PLAN OF UPPER OH V
—
01
—
216250
UPMC
—
01
—
875707
MAMSI
—
Enumeration date
08/09/2005
Last updated
07/08/2007
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