Individual
DR. DAVID CHARLES CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
165 SCOTT AVE, SUITE 100, MORGANTOWN, WV 26508-8847
(304) 554-0400
(304) 554-0404
Mailing address
125 N 6TH ST, CLARKSBURG, WV 26301-2665
(304) 624-7200
(304) 554-0404
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
20946
WV
207N00000X
Dermatology Physician
90420
OH
207N00000X
Dermatology Physician
MD436112
PA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
20946
WV
207ND0101X
MOHS-Micrographic Surgery Physician
90429
OH
207NS0135X
Procedural Dermatology Physician
20946
WV
207NS0135X
Procedural Dermatology Physician
90429
OH
207NS0135X
Procedural Dermatology Physician
MD436112
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1810688000
—
WV
01
—
4216662
MEDICARE ID - TYPE UNSPECIFIED
WV
Enumeration date
12/14/2006
Last updated
01/23/2015
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