Individual
CHARLES VANCE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7400 LYNN AVE, HAMLIN, WV 25523-1138
(304) 824-5806
(304) 824-5804
Mailing address
7400 LYNN AVE, HAMLIN, WV 25523-1138
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
768
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000229369
ANTHEM
WV
01
—
001709560
MT. STATE
WV
05
—
0049874000
—
WV
01
—
080188645
RR MEDICARE
WV
Enumeration date
01/19/2006
Last updated
07/18/2017
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